title: Hospitalization and pharmacotherapy for borderline personality disorder in a psychiatric emergency service.
abstract: OBJECTIVE
  This study aimed to determine factors associated with hospitalization and decisions to prescribe psychotropic medication for patients with borderline personality disorder seeking care at psychiatric emergency units.
  
  
  METHODS
  A total of 11,578 consecutive visits were reviewed over a four-year period at a psychiatric emergency service in a tertiary hospital in Spain. Some patients were repeat visitors. Data collected included sociodemographic, clinical, social, and therapeutic information and the Severity of Psychiatric Illness (SPI) score.
  
  
  RESULTS
  Borderline personality disorder was the diagnosis in 1,032 of the visits (9%) to the emergency department, which corresponded to 540 individuals. Of these visits, 11% required hospitalization. Multivariate statistical logistic regression analysis showed that the decision to hospitalize was associated with risk of suicide, danger to others, severity of symptoms, difficulty with self-care, and noncompliance with treatment. The decision to prescribe benzodiazepines was related to male sex, anxiety as the reason for seeking care, little difficulty with self-care, few medical or drug problems, and housing instability. Factors related to the prescription of antipsychotics were male sex, risk of endangering others, and psychosis as the reason for the visit. Factors associated with the prescription of antidepressants were depression as the reason for seeking help and little premorbid dysfunction.
  
  
  CONCLUSIONS
  Patients with borderline personality disorder had greater clinical severity, but the percentage of hospitalizations was lower than for patients without the disorder. Although a psychiatric emergency service is not the ideal setting to initiate pharmacotherapy, in practice, psychiatrists often prescribe medications in this setting. The SPI was a good tool to assess the severity of illness of these patients.
authors.affiliation: Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Pascual
authors.forename: David
authors.initials: D
authors.lastname: Córcoles
authors.forename: Juan
authors.initials: J
authors.lastname: Castaño
authors.forename: Jose M
authors.initials: JM
authors.lastname: Ginés
authors.forename: Alfredo
authors.initials: A
authors.lastname: Gurrea
authors.forename: Rocio
authors.initials: R
authors.lastname: Martín-Santos
authors.forename: Carlos
authors.initials: C
authors.lastname: Garcia-Ribera
authors.forename: Victor
authors.initials: V
authors.lastname: Pérez
authors.forename: Antonio
authors.initials: A
authors.lastname: Bulbena
mesh_terms: D001883:Borderline Personality Disorder / Q000188:drug therapy*; D003657:Decision Making; D004358:Drug Therapy; D004637:Emergency Services, Psychiatric; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D011446:Prospective Studies; D013030:Spain