A standardized crisis management model for self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder: The Brief Admission Skåne randomized controlled trial protocol (BASRCT)

Abstract

BackgroundBrief Admission is a crisis and risk management strategy in which self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder self-admit to hospital at times of increasing risk when other efforts to stay safe are failing. Standardized in the current randomized controlled trial, the intensity of Brief Admission Skåne is implemented in durations of three days, with a maximum frequency of three times a month. Brief Admission is integrated into existing treatment plans in advance of crises to prevent reliance on general psychiatric admissions for risk management, as these may be lengthy, unstructured, and of uncertain therapeutic value.Methods/designThe overall objective of the Brief Admission Skåne randomized controlled trial is to determine if Brief Admission can replace general psychiatric admission for self-harming and suicidal individuals with complex mental illness at times of escalating risk. Other objectives of the study are to evaluate whether Brief Admission increases daily functioning and enhances coping, reduces psychiatric symptoms including frequency and severity of self-harm and suicidal behaviours. A final objective is to determine if Brief Admission is an effective crisis management model for this population. Participants are randomized at an individual level to either Brief Admission Skåne plus Treatment as Usual or Treatment As Usual. Based on a priori power analyses, N = 124 participants will be recruited to the study. Data collection is in progress, and will continue until June 2018. All participant data are single-blinded and will be handled with intention-to-treat analysis.DiscussionBased on the combined clinical experience of our international research group, the Brief Admission Skåne randomized controlled trial upon which the current protocol is based represents the first initiative to standardize, implement and evaluate Brief Admission amongst self-harming and suicidal individuals, including those with borderline traits. Objectively measuring protocol fidelity and developing English-language Brief Admission study protocols and training materials are implementation and dissemination targets developed in order to facilitate adherent international export of Brief Admission Skåne.Trial registration NCT02985047. Registered November 25, 2016. Retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-017-1371-6) contains supplementary material, which is available to authorized users.

One-Year Consistency in Lifetime Frequency Estimates and Functions of Non-Suicidal Self-Injury in a Clinical Sample

“…When requested, this help was provided. Data was collected at baseline (T1) and after 6 (T2) and 12 (T3) months (40).…”

Treatment of Severe Emotionally Unstable Personality Disorder with Comorbid Ehlers-Danlos Syndrome and Functional Neurological Disorder in an Inpatient Setting: A Case for Specialist Units without Restrictive Interventions

“…There are many limitations to this approach, namely, that patients suffer from chronic, recurrent risk of self-harm and suicide, and there is evidence that repeated admissions to acute wards is associated with increased risk of death by suicide, particularly in women [ 2 ]. Traditional hospital dynamics with an “us v them” narrative encourage power struggles between staff and patient, and this is associated with clinical and functional decompensation and increased risk-taking behaviour [ 18 ].…”

“…The therapeutic relationship is damaged by perceived stigma, such as that of nursing staff feeling “less empathy” towards patients with an EUPD diagnosis compared to other mental disorders [ 1 ]. NICE reports that people who self-harm have an “unacceptable” care experience, due to unconscious emotions of anger and exhaustion experienced by staff [ 18 , 19 ]. The therapeutic relationship on Springbank ward is supported by providing continuity of care in an open, cooperative, and judgement-free environment.…”

La desapropiación corporal: la autopercepción en personas con lesiones permanentes, violencia sexual o tortura crónica

“…La experiencia de SHB incluye: cortarse, quemarse, administrase latigazos (flagelarse), golpearse en regiones del cuerpo, pellizcarse severamente, ruptura de huesos, aplicación de aparatos de tortura en el cuerpo crónicamente, como son los cilicios y otros accesorios para provocar dolor de manera deliberada [20][21][22][23] . Algunas de estas prácticas se han asociado a experiencias tempranas de abuso sexual, sobre todo en mujeres, a quienes se violentaron desde la infancia.…”

“…Al perder sus límites, en situaciones extremas, el cuerpo puede volverse un enemigo, si es que se percibe continuamente como un estado de sufrimiento crónico. Las personas en esta situación pueden mutilar su cuerpo o incluso llegar al suicidio para no tener que seguir presentando este tipo de experiencia extrema 20,21 .…”