Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK.
Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK.
BMC Psychiatry. 2023 Oct 5;23(1):720. doi: 10.1186/s12888-023-05119-7.
People who have been given a diagnosis of a 'personality disorder' need access to good quality mental healthcare when in crisis, but the evidence underpinning crisis services for this group is limited. We synthesised quantitative studies reporting outcomes for people with a 'personality disorder' diagnosis using crisis and acute mental health services.
We searched OVID Medline, PsycInfo, PsycExtra, Web of Science, HMIC, CINAHL Plus, Clinical Trials and Cochrane CENTRAL for randomised controlled trials (RCTs) and observational studies that reported at least one clinical or social outcome following use of crisis and acute care for people given a 'personality disorder' diagnosis. We performed a narrative synthesis of evidence for each model of care found.
We screened 16,953 records resulting in 35 studies included in the review. Studies were published between 1987-2022 and conducted in 13 countries. Six studies were RCTs, the remainder were non randomised controlled studies or cohort studies reporting change over time. Studies were found reporting outcomes for crisis teams, acute hospital admission, acute day units, brief admission, crisis-focused psychotherapies in a number of settings, Mother and Baby units, an early intervention service and joint crisis planning. The evidence for all models of care except brief admission and outpatient-based psychotherapies was assessed as low or very low certainty.
The literature found was sparse and of low quality. There were no high-quality studies that investigated outcomes following use of crisis team or hospital admission for this group. Studies investigating crisis-focused psychological interventions showed potentially promising results.
被诊断为“人格障碍”的人在危机时需要获得高质量的心理健康护理，但针对该群体的危机服务的证据有限。我们综合了定量研究报告，这些研究报告了使用危机和急性心理健康服务后，具有“人格障碍”诊断的人的结果。
我们在 OVID Medline、PsycInfo、PsycExtra、Web of Science、HMIC、CINAHL Plus、Clinical Trials 和 Cochrane CENTRAL 中搜索了随机对照试验（RCT）和观察性研究，这些研究报告了使用危机和急性护理后，具有“人格障碍”诊断的人的至少一项临床或社会结果。我们对每种护理模式的证据进行了叙述性综合。
我们筛选了 16953 条记录，最终有 35 项研究被纳入综述。研究发表于 1987 年至 2022 年期间，在 13 个国家进行。其中 6 项研究为 RCT，其余为非随机对照研究或队列研究，报告了随着时间的推移发生的变化。研究报告了危机小组、急性住院、急性日间单位、短暂住院、在多种环境下进行的以危机为重点的心理治疗、母婴单位、早期干预服务和联合危机规划的结果。除了短暂住院和基于门诊的心理治疗外，所有护理模式的证据均被评估为低或极低确定性。
文献发现稀疏且质量较低。没有高质量的研究调查了该组人群使用危机小组或住院治疗后的结果。调查以危机为重点的心理干预的研究显示出有潜在的希望结果。
