Flynn Sandra, Graney Jane, Nyathi Thabiso, Raphael Jessica, Abraham Seri, Singh-Dernevik Sandeep, Williams Alyson, Kapur Nav, Appleby Louis, Shaw Jenny
Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK.
Greater Manchester Mental Health NHS Foundation Trust, UK.
BJPsych Open. 2020 Mar 18;6(2):e29. doi: 10.1192/bjo.2020.11.
It is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments.
To describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance.
National consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK.
The majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients.
Continuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.
据估计，每10人中就有1人患有个性障碍。情绪不稳定个性障碍患者自杀风险很高。尽管他们经常使用心理健康服务，但患者往往没有明确的途径获得有效治疗。
描述自杀身亡的个性障碍患者的特征，检查临床护理途径，并探讨护理是否符合英国国家卫生与临床优化研究所的指南。
全国连续病例系列研究（2013年1月1日至2013年12月31日）。该研究检查了英国自杀身亡的个性障碍患者的健康记录和严重事件报告。
大多数患者被诊断为边缘型/情绪不稳定或反社会型个性障碍。很大一部分患者有自残史（n = 146，95%）以及酗酒（n = 101，66%）或药物滥用史（n = 79，52%）。我们发现患者在死亡前一年与服务机构有广泛接触，但没有明确的途径。护理不一致，服务提供存在缺口。在有数据的141名患者中，99名（70%）的最后一次护理是在危机之后。获得专门心理治疗的机会有限；短期住院治疗得到了遵循；然而，三分之二的患者未遵循关于合并症短期开药的指南。
需要护理的连续性和稳定性来预防危机，而不是应对处于危机中的个人。建议对英国各地为个性障碍患者提供的服务进行全面审核，以评估所提供护理的质量。
