Severe personality disorders. Treatment issues and selection for in-patient psychotherapy.
BACKGROUND
Severe personality disorder (SPD) is an imprecise but useful term referring to some notoriously difficult to treat psychiatric patients. Their long-term psychiatric treatment is often unsuccessful, in spite of hospitalisation. The specialist expertise of in-patient psychotherapy units (IPUs) can successfully meet some of SPD patients' needs.


METHODS
Relevant literature on the subject is summarised and integrated with the authors' specialist clinical experience.


RESULTS
Many clinical problems with SPD patients are interpersonal and prevent any effective therapeutic alliance, which is necessary for successful treatment. With in-patients, inconsistencies in treatment delivery and issues surrounding compulsory treatment reinforce patients' mistrust of professionals, compromising accurate diagnosis and an assessment of the need for specialist IPU referral.


CONCLUSIONS
General psychiatric teams are well-placed to plan long-term treatment for SPD patients which may include IPU treatment. Timely referral of selected SPD patients to an IPU maximises a successful outcome, especially if there is appropriate post-discharge collaboration with general psychiatric teams to consolidate gains made.
Norton
K
K
Henderson Hospital, Sutton, Surrey.
Hinshelwood
R D
RD
D003131:Combined Modality Therapy; D003617:Dangerous Behavior; D003937:Diagnosis, Differential; D006801:Humans; D010343:Patient Admission; D010552:Personality Assessment; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010817:Physician-Patient Relations; D011567:Psychiatric Department, Hospital; D011613:Psychotherapy; D011619:Psychotropic Drugs / Q000627:therapeutic use; D013038:Specialization; D016896:Treatment Outcome
D011619:Psychotropic Drugs