The Community Perspective

Dr Linda R Treliving

Chair of SPDN

Aims of the Scottish Personality Disorder Network

•To meet at least three times a year•To compose a Network database •To maintain a dedicated website •Initial objectives to explore in more depth

Education and training Research Treatability and pathways of care Users and Carers

•To maintain contact with other relevant Networks, •To make contact with other relevant NHS bodies, •To feed into any relevant work being undertaken by the Scottish Government

“The distinction between personality disorder and mental

illness”

• …… it is commonplace for a diagnosis of personality disorder to be used to justify a decision not to admit someone to a psychiatric ward, or even to accept them for treatment……

B.J.Psych.

Volume 180,February 2002,pp 110-115

KENDELL, R. E.

Personality Disorder

• 10 - 13% of adult population

Torgerson et al(2001)

• 36-67% of psychiatric population Moran P (2002)

Contact with General practitioner 2003/2004

• Practice Population. 308132

Number seen by GP

Estimated number in Scotland

Personality disorder 160 2819

Depression 15,474 269,800

Schizophrenia 293 5130

Psychiatric inpatient discharges, 2000

Main diagnosis of PD 799 ( 3.8%)

All patients 20851

Royal Cornhill Hospital admission wards research

• 136 inpatients

• 95 of the 136 had significant personality disturbance.(70%)

58/74 Males (78%)

37/62 Females (60%)

• 20 had a recorded diagnosis of PD. (7%)

Diagnostic criteria for borderline personality disorder

• Frantic efforts to avoid real or imagined abandonment and chronic feeling of emptiness

• Unstable sense of self

• Unstable and intense relationships

• Impulsivity and recurrent self harm

• Affective instability and inappropriate or intense anger and difficulty dealing with it

Personal relatedness and attachment in infants of mothers with borderline personality disorder

R. PETER HOBSON, MATTHEW PATRICK, LISA CRANDELL,ROSA GARCÍA–PÉREZ, and ANTHONY LEEDevelopment and Psychopathology 17,2005, 329–347Tavistock Clinic, University College, London

Infants of mothers with Borderline personality disorder

•less available for positive engagement•less organized and positive in their emotional state.•disorganized in their pattern of attachment with their mothers,

Mothers with Borderline personality disorder

• in a play teaching task tend to manifest intrusive insensitive behavior.• also found to be less confident, less satisfied and more distressed

393 – 18 year old students with borderline features

• Increased disturbance inParental bonding Attachment

• 2 years later on follow uppoor interpersonal life

poor academic achievementincreased use of medication

increased use of psychological therapy

Mental health service utilization by borderline personality disorder patients followed

prospectively for 6 years

Zanarini, Mary C. Frankenburg, Frances R. Hennen, John. Silk, Kenneth R.

Journal of Clinical Psychiatry. 65(1):28-36, 2004 Jan

• 362 inpatients were interviewed about their treatment histories during their index admission (1992-1995)

• Over 94% of surviving patients were re-interviewed about their psychiatric treatment histories 2, 4, and 6 years later

During the final 2 years of the 6-year follow-up of patients with borderline personality disorder

• 33% of patients were hospitalized (previously 79%)

• 22% were attending day and/or residential treatment (from 55% )

• intensive psychotherapy declined significantly over time (from 36% to 16%),

• intensive polypharmacy remained relatively stable over time, (40% taking 3 or more meds,20% taking 4 or more, 10% taking 5 or more.)

Mary C Zanarini; Frances R Frankenburg; John Hennen; D Bradford Reich; Kenneth R Silk...

The American Journal of Psychiatry; May 2006; 163, 5;

Prediction of the 10-Year Course of Borderline Personality Disorder

At ten year follow up

242 0f 275 patients (88%) were in remission

(no longer fulfilling criteria for BPD)