Likelihood and predictors of detention in patients with personality disorder compared with other mental disorders: A retrospective, quantitative study of Mental Health Act assessments

Olajide, Kike; Tyrer, Peter; Singh, Swaran P.; Burns, Tom; Rugkåsa, Jorun; Thana, Lavanya; Paul, Moli; Islam, Zoebia; Crawford, Mike

doi:10.1002/pmh.1332

Cited by 5 publications

(6 citation statements)

References 12 publications

(11 reference statements)

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“…Nine studies found that suicidal behaviour, ideation, and history were associated with voluntary rather than involuntary hospitali sati on. 17,27,28,43,67,80,82,85,86 In five studies, risk to self was associated with involuntary admission, 7,69,72,74,87 whereas in 17 studies, no association was noted between risk to self and the legal status of admission. 30,34,38,41,42,58,59,71,73,75,77,79,89,91,92,95,96 18 studies reported on risk to others and all noted a positive association with involuntary hospitalisation.…”

Section: Resultsmentioning

confidence: 97%

“…30,34,38,41,42,58,59,71,73,75,77,79,89,91,92,95,96 18 studies reported on risk to others and all noted a positive association with involuntary hospitalisation. 7,17,30,34,41,43,[58][59][60]67,69,[72][73][74]79,80,91,95 However, measurement and definition of risk to others was inconsistent throughout these studies, with scant use of formal assessment scales. Three studies used HONOS to record levels of aggression, 58,59,91 two used the Overt Aggression Scale, 17,73 two used the Risk of Harm to Others Scale, 7,69 two used an item of the Personal and Social Performance scale (disturbing and aggressive behaviour, 41 and danger to others).…”

Section: Resultsmentioning

confidence: 99%

“…Three studies used HONOS to record levels of aggression, 58,59,91 two used the Overt Aggression Scale, 17,73 two used the Risk of Harm to Others Scale, 7,69 two used an item of the Personal and Social Performance scale (disturbing and aggressive behaviour, 41 and danger to others). 95 Four studies used information from patients' notes, 30,43,74,80 but only one of these studies was clear about requiring a record of an actual incident of violent behaviour. 74 In one study, 79 risk to others was assessed by interviews with family members, who were asked if there were any verbal threats to harm someone and aggressive outbursts in the week before admission.…”

Section: Resultsmentioning

confidence: 99%

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Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis

Walker

MacKay

Barnett

et al. 2019

The Lancet Psychiatry

127

159

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Background Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce involuntary hospitalisation. We did a systematic review, meta-analysis, and narrative synthesis to investigate risk factors at the patient, service, and area level associated with involuntary psychiatric hospitalisation of adults.Methods We searched MEDLINE, PsycINFO, Embase, and the Cochrane Controlled Clinical Register of Trials from Jan 1, 1983, to Aug 14, 2019, for studies comparing the characteristics of voluntary and involuntary psychiatric inpatients, and studies investigating the characteristics of involuntarily hospitalised individuals in general population samples. We synthesised results using random effects meta-analysis and narrative synthesis. Our review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered on PROSPERO, CRD42018095103. Findings 77 studies were included from 22 countries. Involuntary rather than voluntary hospitalisation was associated with male gender (odds ratio 1•23, 95% CI 1•14-1•32; p<0•0001), single marital status (1•47, 1•18-1•83; p<0•0001), unemployment (1•43, 1•07-1•90; p=0•020), receiving welfare benefits (1•71, 1•28-2•27; p<0•0001), being diagnosed with a psychotic disorder (2•18, 1•95-2•44; p<0•0001) or bipolar disorder (1•48, 1•24-1•76; p<0•0001), and previous involuntary hospitalisation (2•17, 1•62-2•91; p<0•0001).Using narrative synthesis, we found associations between involuntary psychiatric hospitalisation and perceived risk to others, positive symptoms of psychosis, reduced insight into illness, reduced adherence to treatment before hospitalisation, and police involvement in admission. On a population level, some evidence was noted of a positive dose-response relation between area deprivation and involuntary hospitalisation.Interpretation Previous involuntary hospitalisation and diagnosis of a psychotic disorder were factors associated with the greatest risk of involuntary psychiatric hospitalisation. People with these risk factors represent an important target group for preventive interventions, such as crisis planning. Economic deprivation on an individual level and at the population level was associated with increased risk for involuntary hospitalisation. Mechanisms underpinning the risk factors could not be identified using the available evidence. Further research is therefore needed with an integrative approach, which examines clinical, social, and structural factors, alongside qualitative research into clinical decision-making processes and patients' experiences of the detention process.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis

Walker

MacKay

Barnett

et al. 2019

The Lancet Psychiatry

127

159

View full text Add to dashboard Cite

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“…These studies captured data on individuals having received care in the public hospital system but excluded the least impaired cases (eg, those having received care in the private sector) and the most severely impaired cases (eg, those who ended up in detention without receiving care). 22 It is important to note that these studies highlight the diminishing reluctance of clinicians to diagnose BPD in adolescents, since the work was based on diagnostic data recorded by the adolescent’s treating physicians.…”

Section: Introductionmentioning

confidence: 99%

Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies

Guilé¹,

Boissel²,

Alaux‐Cantin³

et al. 2018

AHMT

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Using the same Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-V) criteria as in adults, borderline personality disorder (BPD) in adolescents is defined as a 1-year pattern of immature personality development with disturbances in at least five of the following domains: efforts to avoid abandonment, unstable interpersonal relationships, identity disturbance, impulsivity, suicidal and self-mutilating behaviors, affective instability, chronic feelings of emptiness, inappropriate intense anger, and stress-related paranoid ideation. BPD can be reliably diagnosed in adolescents as young as 11 years. The available epidemiological studies suggest that the prevalence of BPD in the general population of adolescents is around 3%. The clinical prevalence of BPD ranges from 11% in adolescents consulting at an outpatient clinic to 78% in suicidal adolescents attending an emergency department. The diagnostic procedure is based on a clinical assessment with respect to developmental milestones and the interpersonal context. The key diagnostic criterion is the 1-year duration of symptoms. Standardized, clinician-rated instruments are available for guiding this assessment (eg, the Diagnostic Interview for Borderlines-Revised and the Childhood Interview for DSM-IV-TR BPD). The assessment should include an evaluation of the suicidal risk. Differential diagnosis is a particular challenge, given the high frequency of mixed presentations and comorbidities. With respect to clinical and epidemiological studies, externalizing disorders in childhood constitute a risk factor for developing BPD in early adolescence, whereas adolescent depressive disorders are predictive of BPD in adulthood. The treatment of adolescents with BPD requires commitment from the parents, a cohesive medical team, and a coherent treatment schedule. With regard to evidence-based medicine, psychopharmacological treatment is not recommended and, if ultimately required, should be limited to second-generation antipsychotics. Supportive psychotherapy is the most commonly available first-line treatment. Randomized controlled trials have provided evidence in favor of the use of specific, manualized psychotherapies (dialectic-behavioral therapy, cognitive analytic therapy, and mentalization-based therapy).

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“…Further studies along the same lines as Hossain et al 1 should also examine the proportion of people admitted with personality disorder under the Mental Health Act. Those with personality disorder are sectioned less often after formal assessment than those with other diagnoses, but at 41% the proportion is still substantial 14 and may be increasing. This certainly appears to be the case in those with personality dysfunction and intellectual disability 15 and is a matter of some concern, as in this population the diagnosis of personality disorder is more contentious.…”

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confidence: 99%

Accurate recording of personality disorder in clinical practice

Tyrer

2018

BJPsych Bull

Self Cite

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SummaryDisturbances of personality are recorded very poorly in official statistics, but there are signs that this is changing. For many years, personality disorder has been either regarded as a secondary diagnosis that can be forgotten in the presence of another mental disorder, or avoided as the diagnosis gives the impression of untreatability or stigma. What is now abundantly clear is that under-diagnosis of personality disorder represents a disservice to patients and practitioners. It prevents a proper understanding of the longitudinal course of psychiatric disorder and an appreciation of some of the positive aspects of abnormal personality that can be used in treatment. We must no longer bury personality disorder, ostrich-like, in the diagnostic sand. It is there for the asking and needs to be embraced honestly and without fear if we are to improve the management of psychiatric patients.Declaration of interestNone.

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Likelihood and predictors of detention in patients with personality disorder compared with other mental disorders: A retrospective, quantitative study of Mental Health Act assessments

Abstract: Detention rates in patients with personality disorder are lower than those for other disorders but are still substantial. Risk factors for detention in patients with personality disorder differ from those with other mental disorders. Copyright © 2016 John Wiley & Sons, Ltd.

Cited by 5 publications

References 12 publications

Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis

Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis

Borderline personality disorder in adolescents: prevalence, diagnosis, and treatment strategies

Accurate recording of personality disorder in clinical practice

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