Liljedahl Sophie I, Helleman Marjolein, Daukantaité Daiva, Westrin Åsa, Westling Sofie
Department of Psychology, Lund University, Box 213, SE-221 00, Lund, Sweden.
Department of Clinical Sciences, Lund, Psychiatry, Clinical Psychiatric Research Center, Lund University, Lund, Region Skane, Sweden.
BMC Psychiatry. 2017 Jun 15;17(1):220. doi: 10.1186/s12888-017-1371-6.
Brief Admission is a crisis and risk management strategy in which self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder self-admit to hospital at times of increasing risk when other efforts to stay safe are failing. Standardized in the current randomized controlled trial, the intensity of Brief Admission Skåne is implemented in durations of three days, with a maximum frequency of three times a month. Brief Admission is integrated into existing treatment plans in advance of crises to prevent reliance on general psychiatric admissions for risk management, as these may be lengthy, unstructured, and of uncertain therapeutic value.
METHODS/DESIGN: The overall objective of the Brief Admission Skåne randomized controlled trial is to determine if Brief Admission can replace general psychiatric admission for self-harming and suicidal individuals with complex mental illness at times of escalating risk. Other objectives of the study are to evaluate whether Brief Admission increases daily functioning and enhances coping, reduces psychiatric symptoms including frequency and severity of self-harm and suicidal behaviours. A final objective is to determine if Brief Admission is an effective crisis management model for this population. Participants are randomized at an individual level to either Brief Admission Skåne plus Treatment as Usual or Treatment As Usual. Based on a priori power analyses, N = 124 participants will be recruited to the study. Data collection is in progress, and will continue until June 2018. All participant data are single-blinded and will be handled with intention-to-treat analysis.
Based on the combined clinical experience of our international research group, the Brief Admission Skåne randomized controlled trial upon which the current protocol is based represents the first initiative to standardize, implement and evaluate Brief Admission amongst self-harming and suicidal individuals, including those with borderline traits. Objectively measuring protocol fidelity and developing English-language Brief Admission study protocols and training materials are implementation and dissemination targets developed in order to facilitate adherent international export of Brief Admission Skåne.
NCT02985047 . Registered November 25, 2016. Retrospectively registered.
短期入院是一种危机和风险管理策略，即符合三项或更多边缘性人格障碍诊断标准的自伤和自杀个体，在其他保障安全的措施失效、风险增加时，自行入院治疗。在当前的随机对照试验中，斯坎纳短期入院治疗的强度设定为三天一个疗程，每月最多进行三次。短期入院治疗在危机发生前就被纳入现有的治疗计划中，以避免在风险管理中依赖普通的精神科住院治疗，因为后者可能耗时较长、缺乏条理且治疗价值不确定。
方法/设计：斯坎纳短期入院治疗随机对照试验的总体目标是确定短期入院治疗能否在风险不断升级时，替代普通精神科住院治疗，用于患有复杂精神疾病的自伤和自杀个体。该研究的其他目标包括评估短期入院治疗是否能提高日常功能、增强应对能力、减少精神症状，包括自伤和自杀行为的频率及严重程度。最后一个目标是确定短期入院治疗对这一群体而言是否是一种有效的危机管理模式。参与者在个体层面被随机分配到斯坎纳短期入院治疗加常规治疗组或常规治疗组。根据预先的功效分析，将招募124名参与者参与该研究。数据收集正在进行中，并将持续到2018年6月。所有参与者的数据均采用单盲法，并将进行意向性分析。
基于我们国际研究团队的综合临床经验，本方案所依据的斯坎纳短期入院治疗随机对照试验，是首次对自伤和自杀个体（包括具有边缘性特质的个体）的短期入院治疗进行标准化、实施和评估的举措。客观衡量方案的依从性，并开发英文的短期入院治疗研究方案和培训材料，是为促进斯坎纳短期入院治疗在国际上的可靠推广而制定的实施和传播目标。
NCT02985047。于2016年11月25日注册。追溯注册。
