Paton Carol, Crawford Mike J, Hartley Matthew, Adams Clive E, Edokpolor Pernia Elena M, Rendora Olivia, Barnes Thomas R E
Prescribing Observatory for Mental Health, Royal College of Psychiatrists, London, UK.
Division of Psychiatry, Imperial College London, London, UK.
BJPsych Open. 2025 Aug 1;11(5):e161. doi: 10.1192/bjo.2025.10052.
Clinical guidelines for personality disorder emphasise the importance of patients being supported to develop psychological skills to help them manage their symptoms and behaviours. But where these mechanisms fail, and hospital admission occurs, little is known about how episodes of acutely disturbed behaviour are managed.
To explore the clinical characteristics and management of episodes of acutely disturbed behaviour requiring medication in in-patients with a diagnosis of personality disorder.
Analysis of clinical audit data collected in 2024 by the Prescribing Observatory for Mental Health, as part of a quality improvement programme addressing the pharmacological management of acutely disturbed behaviour. Data were collected from clinical records using a bespoke proforma.
Sixty-two mental health Trusts submitted data on 951 episodes of acutely disturbed behaviour involving patients with a personality disorder, with this being the sole psychiatric diagnosis in 471 (50%). Of the total, 782 (82%) episodes occurred in female patients. Compared with males, episodes in females were three times more likely to involve self-harming behaviour or be considered to pose such a risk (22% and 70% respectively: < 0.001). Parenteral medication (rapid tranquillisation) was administered twice as often in episodes involving females than in males (64 and 34% respectively: < 0.001).
Our findings suggest that there are a large number of episodes of acutely disturbed behaviour on psychiatric wards in women with a diagnosis of personality disorder. These episodes are characterised by self-harm and regularly prompt the administration of rapid tranquillisation. This has potential implications for service design, staff training, and research.
人格障碍临床指南强调支持患者培养心理技能以帮助他们管理症状和行为的重要性。但当这些机制失效且患者需要住院治疗时，对于如何处理急性行为紊乱发作却知之甚少。
探讨诊断为人格障碍的住院患者中，需要药物治疗的急性行为紊乱发作的临床特征及处理方式。
作为针对急性行为紊乱药物治疗的质量改进项目的一部分，对2024年由心理健康处方观察站收集的临床审计数据进行分析。数据通过定制表格从临床记录中收集。
62个心理健康信托机构提交了951例涉及人格障碍患者的急性行为紊乱发作的数据，其中471例（50%）的唯一精神科诊断为人格障碍。在总数中，782例（82%）发作发生在女性患者中。与男性相比，女性发作涉及自我伤害行为或被认为有此类风险的可能性高出三倍（分别为22%和70%：<0.001）。在涉及女性的发作中，肠外用药（快速镇静）的使用频率是男性的两倍（分别为64%和34%：<0.001）。
我们的研究结果表明，诊断为人格障碍的女性精神科病房中有大量急性行为紊乱发作。这些发作的特征是自我伤害，并经常促使进行快速镇静。这对服务设计、员工培训和研究具有潜在影响。
