Treatment models for those with severe mental illness and comorbid personality disorder

Tyrer, Peter; Simmonds, Shaeda

doi:10.1192/bjp.182.44.s15

Cited by 54 publications

(41 citation statements)

References 19 publications

(19 reference statements)

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“…People with personality disorders have fewer attachment and support figures in the community than do others (Tyrer et al, 1994), and few community teams can provide the level of support and treatment needed when function begins to disintegrate. The findings of differential outcomes have been replicated in three randomised trials with over 900 patients (Tyrer & Simmonds, 2003) and cannot be lightly ignored.…”

Section: Box 4 Engagement and Maintenance In Treatmentmentioning

confidence: 54%

Services for personality disorder: organisation for inclusion

Bateman¹,

Tyrer²

2004

Adv. psychiatr. treat

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Mental health services are not yet organised to allow patients with personality disorders easy access, and practitioners lack the necessary skills to implement effective treatment. A number of service models have developed, albeit without a clear evidence-base. These include sole-practitioner, divided-functions and specialist-team models. In general, a divided-functions or specialist-team model is probably best for reducing risk and improving outcomes. Both models present difficulties with integrating treatment, but these can be overcome by good communication. Good management of patients requires careful assessment of need and risk, a consistent approach, constancy of staff, team coherence and adequate inpatient support. Not all practitioners can treat patients with personality disorders and the interpersonal skills of the mental health professional may be crucial in maintaining a patient in treatment.

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Section: Box 4 Engagement and Maintenance In Treatmentmentioning

confidence: 54%

Services for personality disorder: organisation for inclusion

Bateman¹,

Tyrer²

2004

Adv. psychiatr. treat

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“…Tyrer and Simmonds [7] reviewed the outcome of three randomised controlled trials that investigated different models of care in SMI, and found in post-hoc analyses that patients with co-morbid PD spent more time in hospital compared to those without co-morbid PD, regardless of the model of care. Keown and others investigated psychiatric bed use amongst SMI patients seen in a UK community mental health team, and found that the concurrent presence of PD and also severity of PD were associated with increased psychiatric bed use amongst SMI patients [7][6]. Our finding that co-morbid PD increases inpatient service use in SMI patients is consistent with existing evidence that co-morbid personality pathology worsens outcomes in SMI [24] [27].…”

Section: Previous Work and Possible Mechanismsmentioning

confidence: 99%

“…Patients with SMI and co-morbid PD are likely to require tailored interventions that target both the underlying personality pathology as well as the Axis I disorder. In this respect, better treatment models are required to help to reduce admissions and involuntary hospitalization for patients with SMI and comorbid Axis II pathology [7][41] [44].…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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The impact of co-morbid personality disorder on use of psychiatric services and involuntary hospitalization in people with severe mental illness

Fok

Stewart

Hayes

et al. 2014

Soc Psychiatry Psychiatr Epidemiol

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Purpose:To examine the impact of co-morbid personality disorder (PD), on inpatient and community-based service use and risk of involuntary hospitalization, amongst patients with severe mental illness (SMI). Methods:We identified SMI cases (schizophrenia, schizoaffective and bipolar disorder) with and without comorbid PD, and PD cases, aged ≥18 years, in a large secondary mental healthcare case register. Using multivariable logistic regression, we examined the association between co-morbid PD and high level of inpatient and community-based service use (defined as the top decile of service use), and involuntary hospitalization, respectively, adjusting for socio-demographics, clinical symptoms and social functioning. Results:SMI patients with co-morbid PD (SMI-PD) (n=961) had more severe symptoms and social functioning problems compared to SMI patients without PD (n=10,963) and patients who had PD but no concurrent SMI (n=2,309). A greater proportion of SMI-PD patients were high inpatient service users (22.4% vs. 10.1%). This association was attenuated but remained significant, after adjustment (fully adjusted odds ratio, OR: 2.31, 95% CI 1.88 -2.84). The association between SMI-PD and high community-based service use was confounded by symptoms and social functioning. Compared to patients with SMI, SMI-PD patients were significantly more likely to experience involuntary hospitalization (fully adjusted OR 1.56, 95% CI 1.31 -1.85). Conclusions:In SMI patients, co-morbidity with PD is robustly associated with both high use of inpatient psychiatric services and an increased likelihood of involuntary hospitalization. Patients with SMI and 3 co-morbid PD are likely to require tailored interventions that target both the underlying personality pathology as well as the Axis I disorder.

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“…A systematic literature review of outpatient treatment for individuals with psychosis and PD identified only 2 satisfactory UK trials-early community intervention, compared with hospitalization, and community-focused care, compared with standard care. 161 Comorbid groups fared worse in the community. In the United States, using the MacArthur study 75 multisite risk study cohort, patient perceptions of their treatment need, treatment adherence, and treatment effectiveness were each associated with reduced odds of violence during 6 months as outpatients.…”

Section: Treatment Modelsmentioning

confidence: 99%

Psychosis and Violence: Stories, Fears, and Reality

Taylor

2008

Can J Psychiatry

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Individuals with psychosis are often feared. In fact, they are themselves likely to be victims of violence; however, the main aim of this review is to provide an overview of the evidence on relations between psychosis and violence to others. The terms psychosis and violence were used in a literature search limited to the Cochrane Library and PubMed, a manual search of 8 journals, and a follow-up of additional references in the articles found. The overview draws on new empirical data and major reviews. Almost all sound epidemiologic data on psychosis and violence dates from 1990. There is consistency on a small but significant relation between schizophrenia and violent acts. Since then there has also been movement toward understanding the nature of associations and progress on strategies for managing individuals who have psychosis and are violent. Public fears about individuals with psychotic illnesses are largely unfounded, although there would be benefit in greater attention to the safety of those in their close social circle. The task for the next 10 years must be the development and application of knowledge to improve specific treatments—that is, interventions that go beyond holding and caring to bring about substantial change.

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Treatment models for those with severe mental illness and comorbid personality disorder

Cited by 54 publications

References 19 publications

Services for personality disorder: organisation for inclusion

Services for personality disorder: organisation for inclusion

The impact of co-morbid personality disorder on use of psychiatric services and involuntary hospitalization in people with severe mental illness

Psychosis and Violence: Stories, Fears, and Reality

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