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New frontiers in the role of hospitalization for patients with personality disorders

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Abstract

The question of hospitalization in patients who suffer from a borderline personality disorder is very contentious. Through a case-based approach, this review article highlights the issues that surround this controversy. It then reviews the current practice guidelines and examines the evidence for various forms of hospitalization. A synthesis of this information leads to practical recommendations for the management of this challenging population.

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References and Recommended Reading

  1. Oldham JM, Gabbard GO, Goin MK, et al.: Practice guidelines for the treatment of borderline personality disorder. Am J Psychiatry 2001, 158:1–52.

    Article  Google Scholar 

  2. Gunderson JG: Borderline Personality Disorder: A Clinical Guide. Washington, DC: American Psychiatric Press; 2001.

    Google Scholar 

  3. Soloff PH, Lynch KG, Kelly TM, et al.: Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder: a comparative study. Am J Psychiatry 2000, 157:601–608.

    Article  PubMed  CAS  Google Scholar 

  4. Paris J, Brown R, Nowlis D: Long-term follow up of borderline patients in a general hospital. Compr Psychiatry 1987, 28:530–535.

    Article  PubMed  CAS  Google Scholar 

  5. Stone MH: The Fate of Borderline Patients. New York: Guilford Press; 1990.

    Google Scholar 

  6. Paris J, Zweig-Frank H: A twenty-seven year follow up of borderline patients. Compr Psychiatry 2001, 42:482–487.

    Article  PubMed  CAS  Google Scholar 

  7. Maris RW, Canetto SS, McIntosh JL, et al., eds: Review of Suicidology. New York: Guilford Press; 2000.

    Google Scholar 

  8. Gunderson JG, Phillips KA: A current view of the interface between borderline personality disorder and depression. Am J Psychiatry 1991, 148:967–975.

    PubMed  CAS  Google Scholar 

  9. Koenisberg HW, Harvey PD, Mitropoulou V, et al.: Characterizing affective instability in borderline personality disorder. Am J Psychiatry 2002, 159:784–788.

    Article  Google Scholar 

  10. Brown MZ, Comtois KA, Linehan MM: Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder. J Abnorm Psychol 2002, 111:198–202.

    Article  PubMed  Google Scholar 

  11. Leibenluft E, Gardner DL, Cowdry RW: The inner experience of the borderline self-mutilator. J Personal Disord 1987, 1:317–324.

    Google Scholar 

  12. Pokorny AD: Prediction of suicide in psychiatric patients: report of a prospective study. Arch Gen Psychiatry 1982, 40:249–257.

    Google Scholar 

  13. Goldstein RB, Black DW, Nasrallah A, et al.: The prediction of suicide. Arch Gen Psychiatry 1991, 48:418–422.

    PubMed  CAS  Google Scholar 

  14. Paris J: Is hospitalization useful for suicidal patients with borderline personality disorder? J Personal Disord 2004, 18:240–247.

    Article  PubMed  Google Scholar 

  15. Linehan MM: Cognitive Behavioural Therapy of Borderline Personality Disorder. New York: Guilford Press; 1993.

    Google Scholar 

  16. Gutheil TG: Suicide and suit: liability after self-destruction. In Suicide and Clinical Practice. Edited by Jacobs D. Washington, DC: American Psychiatric Press; 1992.

    Google Scholar 

  17. Homqvist R: Staff feelings and patient diagnosis. Can J Psychiatry 2000, 45:349–356.

    Google Scholar 

  18. Dawson D, MacMillan HL: Relationship Management of the Borderline Patient: From Understanding to Treatment. New York: Brunner/Mazel; 1993.

    Google Scholar 

  19. Vijay NR, Langley J, Links PS: Adolescent personality disorders in adolescent medicine. Adolesc Med Clin 2006, 17:115–130.

    PubMed  Google Scholar 

  20. Zanarini MC, Frankenburg FR, Hennen J, et al.: Axis I comorbidity in patients with borderline personality disorder: 6 year follow-up and prediction of time to remission. Am J Psychiatry 2004, 161:2108–2114.

    Article  PubMed  Google Scholar 

  21. Links PS, Cook M, Quastel A: Pharmacologic management of borderline personality disorder: a case study. Essent Psychopharmacol 2005, 6:319–330.

    PubMed  Google Scholar 

  22. Paris J: Chronic suicidality among patients with borderline personality disorder. Psychiatr Serv 2002, 53:738–742.

    Article  PubMed  Google Scholar 

  23. McGlashan TH: The borderline personality disorder practice guidelines: the good, the bad and the realistic. J Personal Disord 2002, 16:119–121.

    Article  PubMed  CAS  Google Scholar 

  24. Merson S, Tyrer P, Onyett S, et al.: Early intervention in psychiatric emergencies: a controlled clinical trial. Lancet 1992, 339:1311–1314.

    Article  PubMed  CAS  Google Scholar 

  25. Tyrer P, Merson S, Onyett S, et al.: The effect of personality disorder on clinical outcome, social networks and adjustment: a controlled trial of psychiatric emergencies. Psychol Med 1994, 24:731–740.

    Article  PubMed  CAS  Google Scholar 

  26. Tyrer P, Evans K, Gandhi N, et al.: Randomised controlled trial of two models of care for discharged psychotic patients. BMJ 1998, 316:106–109.

    PubMed  CAS  Google Scholar 

  27. Gandhi N, Tyrer P, Evans K, et al.: A randomised controlled trial of community oriented and hospital oriented care for discharged psychiatric patients: influence of personality disorder on police contacts. J Personal Disord 2001, 15:94–102.

    Article  PubMed  CAS  Google Scholar 

  28. Burns T, Creed F, Fahy T, et al.: Intensive versus attached case management for severe psychotic illness: a randomised trial. UK 700 Group. Lancet 1999, 353:2185–2189.

    Article  PubMed  CAS  Google Scholar 

  29. Tyrer P, Manley C, Van Horn E, et al.: Personality abnormality in severe mental illness and its influence on outcome of intensive and standard case management: a randomised controlled trial. Eur Psychiatry 2000, 15(Suppl 1):7–10.

    PubMed  Google Scholar 

  30. Bateman A, Fonagy P: Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial. Am J Psychiatry 1999, 156:1563–1569.

    PubMed  CAS  Google Scholar 

  31. Bateman A, Fonagy P: Treatment of borderline personality disorder with psychoanalytically oriented partial hospitalization: an 18 month follow-up. Am J Psychiatry 2001, 158:36–42.

    Article  PubMed  CAS  Google Scholar 

  32. Bateman A, Fonagy P: Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care. Am J Psychiatry 2003, 160:169–171.

    Article  PubMed  Google Scholar 

  33. Chiesa M, Fonagy P, Holmes J, et al.: Residential versus community treatment of personality disorders: a comparative study of three treatment programs. Am J Psychiatry 2004, 161:1463–1470.

    Article  PubMed  Google Scholar 

  34. Ogrodniczuk JS, Piper WE: Day treatment for personality disorders: a review of research findings. Harvard Rev Psychiatry 2001, 9:105–117.

    Article  CAS  Google Scholar 

  35. Vaglum P, Friis S, Irion T, et al.: Treatment response of severe and nonsevere personality disorders in a therapeutic community day unit. J Personal Disord 1990, 4:161–172.

    Google Scholar 

  36. Karterud S, Valgum S, Friis S, et al.: Day hospital therapeutic community treatment for patients with personality disorders. An empirical evaluation of the containment function. J Nerv Ment Dis 1992, 180:238–243.

    Article  PubMed  CAS  Google Scholar 

  37. Mehlum L, Friis S, Irion T, et al.: Personality disorders 2–5 years after treatment: a prospective follow-up study. Acta Psychiatr Scand 1991, 84:72–77.

    PubMed  CAS  Google Scholar 

  38. Piper WE, Rosie JS, Azim HF, Joyce AS: A randomized trial of psychiatric day treatment for patients with affective and personality disorders. Hosp Community Psychiatry 1993, 44:757–763.

    PubMed  CAS  Google Scholar 

  39. Krawitz R: A prospective psychotherapy outcome study. Aust N Z J Psychiatry 1997, 31:465–473.

    PubMed  CAS  Google Scholar 

  40. Wilberg T, Karterud S, Urnes O, et al.: Outcomes of poorly functioning patients with personality disorders in a day treatment program. Psychiatr Serv 1998, 49:1462–1467.

    PubMed  CAS  Google Scholar 

  41. Wilberg T, Urness O, Friis S, et al.: One year follow-up of day treatment for poorly functioning patients with personality disorders. Psychiatr Serv 1999, 50:1326–1330.

    PubMed  CAS  Google Scholar 

  42. Wilberg T, Friis S, Karterud S, et al.: Outpatient group psychotherapy: a valuable continuation treatment for patients with borderline personality disorder treated in a day hospital—a three year follow-up study. Nord J Psychiatry 1998, 52:213–221.

    Article  Google Scholar 

  43. Links PS: Developing effective services for patients with personality disorders. Can J Psychiatry 1998, 43:251–259.

    PubMed  CAS  Google Scholar 

  44. Stein LI, Test MA: Alternative to mental hospital treatment. Arch Gen Psychiatry 1980, 37:392–397.

    PubMed  CAS  Google Scholar 

  45. Bond GR, Witheridge TF, Dincin J, et al.: Assertive community treatment for frequent users of psychiatric hospitals in a large city: a controlled study. Am J Community Psychol 1990, 18:866–869.

    Article  Google Scholar 

  46. Weisbrod BA, Test MA, Stein LI: Alternative to mental hospital treatment. II. Economic benefit-cost analysis. Arch Gen Psychiatry 1980, 37:400–405.

    PubMed  CAS  Google Scholar 

  47. Bush CT, Langford MW, Rosen P, et al.: Operative outreach: intensive case management for severely psychiatrically disturbed adults. Hosp Community Psychiatry 1990, 41:647–649.

    PubMed  CAS  Google Scholar 

  48. Wilson D, Tien G, Eaves D: Increasing the community tenure of mentally disordered offenders: an assertive case management program. Int J Law Psychiatry 1995, 18:61–69.

    Article  PubMed  CAS  Google Scholar 

  49. Wasylenki DA, Goering PN, Lemire D, et al.: The hostel outreach program: assertive case management for homeless mentally ill persons. Hosp Community Psychiatry 1993, 44:848–853.

    PubMed  CAS  Google Scholar 

  50. Zanarini MC: A two-six-year follow-up of borderline outpatients and Axis II controls. Paper presented at the International Congress on the Disorders of Personality. Cambridge, MA; September 9–11, 1993.

  51. Giesen-Bloo J, Van Dyck R, Spinhoven P, et al.: Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Arch Gen Psychiatry 2006, 63:649–658.

    Article  PubMed  Google Scholar 

  52. Linehan M: Cognitive Behavioural Treatment of Borderline Personality Disorder. New York: Guilford Press; 1993.

    Google Scholar 

  53. Bohus M, Haaf B, Simms T, et al.: Effectiveness of inpatient dialectical behavioural therapy for borderline personality disorder: a controlled trial. Behav Res Ther 2004, 42:487–499.

    Article  PubMed  Google Scholar 

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Correspondence to Nishka R. Vijay MD, FRCP(C).

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Vijay, N.R., Links, P.S. New frontiers in the role of hospitalization for patients with personality disorders. Curr Psychiatry Rep 9, 63–67 (2007). https://doi.org/10.1007/s11920-007-0011-0

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