Norton K, Hinshelwood R D
Henderson Hospital, Sutton, Surrey.
Br J Psychiatry. 1996 Jun;168(6):723-31. doi: 10.1192/bjp.168.6.723.
Severe personality disorder (SPD) is an imprecise but useful term referring to some notoriously difficult to treat psychiatric patients. Their long-term psychiatric treatment is often unsuccessful, in spite of hospitalisation. The specialist expertise of in-patient psychotherapy units (IPUs) can successfully meet some of SPD patients' needs.
Relevant literature on the subject is summarised and integrated with the authors' specialist clinical experience.
Many clinical problems with SPD patients are interpersonal and prevent any effective therapeutic alliance, which is necessary for successful treatment. With in-patients, inconsistencies in treatment delivery and issues surrounding compulsory treatment reinforce patients' mistrust of professionals, compromising accurate diagnosis and an assessment of the need for specialist IPU referral.
General psychiatric teams are well-placed to plan long-term treatment for SPD patients which may include IPU treatment. Timely referral of selected SPD patients to an IPU maximises a successful outcome, especially if there is appropriate post-discharge collaboration with general psychiatric teams to consolidate gains made.
严重人格障碍（SPD）是一个不太精确但很有用的术语，指的是一些众所周知的难以治疗的精神病患者。尽管住院治疗，他们的长期精神治疗往往不成功。住院心理治疗单元（IPU）的专业知识能够成功满足部分SPD患者的需求。
总结关于该主题的相关文献，并与作者的专业临床经验相结合。
SPD患者存在许多临床问题，这些问题涉及人际关系，阻碍了任何有效的治疗联盟的建立，而治疗联盟是成功治疗所必需的。对于住院患者，治疗实施过程中的不一致以及围绕强制治疗的问题加剧了患者对专业人员的不信任，从而影响准确诊断以及对转介至专业IPU必要性的评估。
普通精神科团队很适合为SPD患者规划长期治疗，其中可能包括IPU治疗。及时将选定的SPD患者转介至IPU可使治疗成功的可能性最大化，尤其是在出院后与普通精神科团队进行适当合作以巩固治疗成果的情况下。
