Developing effective services for patients with personality disorders.
OBJECTIVE
This review focused on empirical research that addressed the effectiveness of service models for the care of patients with personality disorders.


METHODS
Services discussed included those delivering acute care, such as crisis and emergency services and acute psychiatric hospitalization; continuing care, such as outpatient services, day hospital treatment, and assertive community treatment programs; and other community programming, such as integrated treatment for comorbid substance abuse and psychoeducational interventions for families of patients with personality disorders. The review focused on studies that included patients with personality disorders, and it measured outcomes relevant to patients with personality disorders. Evidence from randomized controlled trials was highlighted.


RESULTS
Few systematic studies of acute services were available. Community programming can decrease the risk of suicide attempts and reliance on inpatient admissions. Services must develop methods of ensuring compliance with treatment. Assertive community treatment for Axis II patients should be developed, implemented, and tested. Comprehensive programming for patients with personality disorders must include integrated treatment for substance abuse and family psychoeducational programs.


CONCLUSIONS
Promising new models of care for patients with personality disorders are ready for testing and wider application.
Links
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Department of Psychiatry, Wellesley/Central Hospital, University of Toronto, Ontario.
D000359:Aftercare / Q000379:methods / Q000592:standards; D000553:Ambulatory Care / Q000592:standards; D019090:Case Management / Q000592:standards* / Q000639:trends; D002986:Clinical Trials as Topic; D003153:Community Health Services / Q000379:methods / Q000592:standards; D003419:Crisis Intervention / Q000592:standards; D003695:Delivery of Health Care / Q000145:classification / Q000592:standards* / Q000639:trends; D006760:Hospitalization; D006801:Humans; D008134:Long-Term Care / Q000592:standards; D008605:Mental Health Services / Q000592:standards* / Q000639:trends; D010043:Outcome and Process Assessment, Health Care; D010554:Personality Disorders / Q000150:complications / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods / Q000592:standards; D013406:Suicide, Attempted / Q000517:prevention & control