University Psychiatric Clinics (UPK), University of Basel, Switzerland.
Faculty of Medicine, University of Basel, Switzerland.
Int J Soc Psychiatry. 2024 Dec;70(8):1516-1524. doi: 10.1177/00207640241277161. Epub 2024 Sep 4.
Acute crises in patients with personality disorders (PD) are often accompanied by suicidal and self-harming behavior. Their management is challenging, as both coercive measures and prolonged inpatient-treatment are known to be counterproductive. Only in crises that cannot be controlled by outpatient means, inpatient treatment is to be taken into account. This treatment should be time-limited and not involve coercion.
The aim of this study was to assess if the introduction of a specialized crisis intervention track is associated with a reduction of coercive measures as well as a shorter in-hospital stay in PD patients.
In this 8-year, hospital-wide, longitudinal, observational study, we investigated the frequency of coercive measures and the median length of in-hospital stay in 1,752 inpatient-cases with PD admitted to the Adult Psychiatry, UPK, Basel, Switzerland, between 01.01.2012 and 31.12.2019. By means of an interrupted-time-series analysis, we compared the period before and after the implementation of a specialized crisis intervention track for PD patients.
Our data show a significant decrease in the median length of in-hospital stay and no significant reduction in the incidence rate of coercion among PD patients after the intervention. The latter is likely due to a floor effect, since there was a significant decrease in coercive measures over the entire observation period, already reaching very low rates before the intervention.
Our study underlines the clinical importance of specialized short-term crisis management in PD, which comes along with shorter lengths of in-hospital stays and a stable low rate of coercive measure.
人格障碍（PD）患者的急性危机常伴有自杀和自残行为。其管理具有挑战性，因为众所周知，强制性措施和长期住院治疗都适得其反。只有在无法通过门诊手段控制的危机中，才应考虑住院治疗。这种治疗应限时且不涉及强制。
本研究旨在评估引入专门的危机干预轨道是否与减少强制性措施以及 PD 患者住院时间缩短有关。
在这项为期 8 年的、全院范围内的、纵向的、观察性研究中，我们调查了瑞士巴塞尔 UPK 成人精神病学系 1752 例 PD 住院患者的强制性措施频率和住院中位数。通过中断时间序列分析，我们比较了专门的 PD 患者危机干预轨道实施前后的时间段。
我们的数据显示，PD 患者的住院中位数显著缩短，而强制性措施的发生率没有显著降低。后者可能是由于地板效应，因为在整个观察期间，强制性措施显著减少，甚至在干预之前就已经达到非常低的水平。
我们的研究强调了 PD 患者专门的短期危机管理的临床重要性，这伴随着住院时间缩短和强制性措施的稳定低比率。
