BackgroundCurrent categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance.MethodsThe sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder).ResultsThe proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p < 0.05) from the other groups regarding the BDI, 15D, and MHI-5 scores as well as the number of Axis I diagnoses. Patients with complex/severe personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant.ConclusionsAn elevated severity level of personality disturbance is associated with an increase in psychiatric morbidity and social dysfunction. Diagnostically sub-threshold personality difficulties are of clinical significance and the degree of impairment corresponds to actual personality disorders. Since these two groups did not significantly differ from each other, our findings also highlight the complexity related to the use of diagnostic thresholds for separate personality disorders.
BackgroundHealth-Related Quality of Life has been considered suitable for outcome measurements in chronic illnesses.MethodsFeasibility of collecting routinely data on health gains during treatment was assessed during a outpatient service development project in Satakunta hospital district. Finland. Patients contacting the outpatient services for the first time were asked to fill in scales during their first visit. The sacles were sent by mail three months, one year and two years after the first visit. The instruments used were AUDIT-5, BDI-21 and 15D. 15D is a scale developed for purposes of estimating QALY’s in health economic research. It has been widely used in Finland in general population and patient populations including psychiatric patients. Previous studies have defined a population standard (0.9402 out of a score of 1) for 15D assessments and a universal cut-point (change of 0.03) for clinically significant change.ResultsThe use of routine-based outcome measurement has been well feasible in outpatient care. So far 949 patients have undergone the first measurement point, 590 the second assessment point and 312 the third assessment point. The data collection is still on-going and numbers of responses at later intervals are likely to increase. At the first assessment the mean 15D score was 0.7616, at three months 0.7857 and at one year 0.7995. Scores increased especially concerning anxiety and depression, but considerably less regarding sleep.ConclusionRoutine measurement of health gains is feasible within the context of public psychiatric services. Measurement implied also need for development of insomnia treatment.
Anne Kuusisto, FT, Satakunnan sairaanhoitopiiri, FI-28500 Pori, FINLAND. Sähköposti: anne.kuusisto@satshp.fi Tiivistelmä Potilaan sujuvan ja turvallisen kotiutumisen edistämiseksi tarvitaan kotiutuskäytäntöjen yhtenäistämistä ja sähköisen hoitotyön yhteenvedon tietosisällön parantamista. Kotiutuslistan käytöllä voidaan parantaa potilaan hoidon jatkuvuutta ja laatua. Se auttaa muistuttamaan hoidon jatkuvuuden kannalta oleellisista asioista hoitojakson aikana, ja sitä voidaan hyödyntää esimerkiksi sähköisen hoitotyön yhteenvedon laatimisessa.Kuvaamme tässä artikkelissa moniammatillisen kotiutuslistan tietosisällön kehittämistä hoitokertomukseen potilaan tulotilanteen ja hoitojakson aikaisen kirjaamisen yhtenäistämiseksi kirjallisuuden sekä erikoissairaanhoidossa, perusterveydenhuollossa ja sosiaalipalveluissa työskentelevien ammattilaisten (n = 82) yhteistyön tuloksena.Kotiutuslistaan sisällytettiin aikaisemman kirjallisuuden, käytössä olleiden paperisten kotiutuslistaesimerkkien ja moniammatillisten työryhmien tuotoksena syntyneitä potilaan turvallisen kotiutuksen kannalta keskeisiä tarkasteltavia asioita. Kotiutuslista pilotoitiin Satakunnan sairaanhoitopiirissä. Pilotointi toteutettiin kolmella keskussairaalan vuodeosastolla, keuhkosairauksilla, sisätaudeilla ja neurologialla, sekä vanhuspsykiatrian ja kuntoutuksen vuodeosastoilla paperimuodossa. Pilotoitu tietosisältö siirrettiin sähköiseen muotoon Effican hoitokertomukseen (hokeen) osaksi potilaan kliinistä hoitosuunnitelmaa.Moniammatillinen kotiutuslista otettiin pilotin jälkeen käyttöön Satakunnan erikoissairaanhoidon palveluissa. Kotiutuslistan keskeisimmät jatkokehittämistarpeet kohdistuvat asiakas-ja potilasnäkökulman esille saamiseen sekä sen tekniseen toimivuuteen potilastietojärjestelmässä.Avainsanat: hoidon jatkuvuus, potilaan kotiuttaminen, tarkistuslista, rakenteinen kirjaaminen, hoitotyön yhteenveto AbstractTo promote effective and safe patient discharge, it is necessary to harmonize discharge practices and improve the content of the electronic nursing discharge summary. The use of a discharge checklist can improve the continuity and quality of patient's care. It helps to remind of the essential things that are relevant to the continuity of care during the care period and can used in, for example, the compilation of an electronic nursing discharge summary.
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