title: [Should hospitalization be required after the emergency discharge of patients with borderline personality disorder who have attempted suicide (FRENCH CRISIS cohort)?].
abstract: BACKGROUND
  Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability and impulsivity. There is a high prevalence of BPD patients among those admitted to the emergency department for suicide attempts. However, little empirical research exists to assist clinicians in deciding whether to hospitalize a suicidal patient. Some authors have argued that hospitalization does not prevent suicide and could actually harm these patients, thereby leading to psychosocial regression. Parasuicidal behaviors could be reinforced by the attention given during hospitalization.
  
  
  OBJECTIVE
  Our purpose was to determine whether the hospitalization of suicidal patients who have a high risk of BPD after discharge from the emergency department is associated with a recurrence of suicidal behavior at 6months.
  
  
  METHODS
  We designed a prospective study, acquiring patients from three emergency hospitals. The participants were suicidal subjects admitted for voluntary drug intoxication and were 18years of age or older. The participants completed the Personality Disorder Questionnaire (PDQ-4+) to assess BPD symptomatology. Information on the recurrence of suicidal behavior at 6months was obtained by interview of patients and the review of the charts from the 3 hospitals involved in the study. Other assessments included the BDI-13 (severity of depression), the Hopelessness Scale (hopelessness), the TAS-20 (alexythymia), the AUDIT (alcohol disorder) and the MINI (axis I disorders).
  
  
  RESULTS
  A total of 606 subjects admitted for a suicide attempt participated in this study. A total of 320 (52.8 %) of the subjects completed the PDQ-4+. The sample was divided into three groups: participants at high risk of having at least one BPD (n=197), a group at high risk of having at least one non-BPD PD (n=84) and a group with low risk of having a PD (n=39). Hospitalization following an emergency was not associated with a recurrence of suicide attempts at 6months among patients at high risk of BPD. A logistical regression analysis showed pre-hospitalization antidepressant prescription to be associated with recidivism (OR=2.1, P=.037).
  
  
  CONCLUSIONS
  Our exploratory study suggests that hospitalization may not increase suicide attempts among patients with BPD when the health organization does not include a specific device such as DBT.
authors.affiliation: Inserm, CIC 9302 Toulouse, hôpital Purpan, CHU de Toulouse, TSA 40031, place Baylac, 31059 Toulouse cedex, France. Electronic address: cailhol.l@chu-toulouse.fr.
authors.forename: L
authors.initials: L
authors.lastname: Cailhol
authors.affiliation: Inserm, CIC 9302 Toulouse, hôpital Purpan, CHU de Toulouse, TSA 40031, place Baylac, 31059 Toulouse cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Riedi
authors.affiliation: Urgences psychiatriques, hôpital Purpan, CHU de Toulouse, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Mathur
authors.affiliation: UPS, laboratoire du stress traumatique (LST - EA 4560), université de Toulouse, 31059 Toulouse, France.
authors.forename: P
authors.initials: P
authors.lastname: Czapla
authors.affiliation: Urgences psychiatriques, hôpital Purpan, CHU de Toulouse, Toulouse, France.
authors.forename: S
authors.initials: S
authors.lastname: Charpentier
authors.affiliation: Anesthésie et soins intensifs, hôpital Purpan, CHU de Toulouse, Toulouse, France.
authors.forename: M
authors.initials: M
authors.lastname: Genestal
authors.affiliation: UPS, laboratoire du stress traumatique (LST - EA 4560), université de Toulouse, 31059 Toulouse, France.
authors.forename: P
authors.initials: P
authors.lastname: Birmes
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001288:Attention; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D015331:Cohort Studies; D003134:Commitment of Persons with Psychiatric Disorders; D004637:Emergency Services, Psychiatric; D005260:Female; D065026:Hope; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010555:Personality Inventory / Q000706:statistics & numerical data; D011446:Prospective Studies; D011594:Psychometrics; D012008:Recurrence; D012043:Regression, Psychology; D018570:Risk Assessment; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology*
chemical_list: D000928:Antidepressive Agents
keywords: Borderline personality disorder; Emergency department; Hospitalisation; Hospitalization; Suicide attempt; Tentative de suicide; Trouble de personnalité borderline; Urgences