Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 2/2014

01-02-2014 | Original Paper

The impact of a diagnosis of personality disorder on service usage in an adult Community Mental Health Team

Authors: M. Byrne, S. Henagulph, R. J. McIvor, J. Ramsey, J. Carson

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 2/2014

Login to get access

Abstract

Purpose

Patients with a diagnosis of personality disorder (PD) have multiple and diverse needs. It has been noted that individuals with personality disorder are high users of health care resources, especially psychiatric services, ambulance services and emergency departments. In addition PD has been shown to be a significant predictor of disability and mental health consultations independent of Axis I disorders and physical conditions. This study aimed to compare the patterns of service usage, clinical ratings of symptoms and functioning, as well as demographic and clinically relevant historical variables between a group of patients with PD and a random sample of all other patients registered with a South London Community Mental Health Team.

Methods

A case–control design was used to examine service usage patterns over a one-year period for 73 cases and 96 controls. Diagnoses were established by clinician discussion. Clinical outcomes were measured with Health of the Nation Outcome Scales and Global Assessment of Functioning, while service use was recorded using ten variables obtained from case note review.

Results

People with a diagnosis of PD were more often white and had a history of abuse, particularly childhood emotional abuse. They were higher users of some aspects of the service as compared to controls, and had significantly higher severity of symptoms and poorer functioning on clinician-rated measures.

Conclusion

This study confirms previous findings that people with PD have more severe symptomatology and greater degrees of functional impairment when compared to those without. Community clinicians should routinely screen attenders to predict likely difficulties that might arise and to make provision for these difficulties in the treatment and management of clients.
Footnotes
1
All patients in services were at that time categorised as having standard or enhanced needs.
 
Literature
1.
Davison SE (2002) Principles of managing patients with personality disorder. Adv Psychiatr Treat 8:1–9CrossRef
2.
Chiesa M, Fonagy P, Holmes J, Drahorad C, Harrison-Hall A (2002) Health service use costs by personality disorder following specialist and nonspecialist treatment: a comparative study. J Pers Disord 16:160–173PubMedCrossRef
3.
Jackson HJ, Burgess PM (2002) Personality disorders in the community: results from the Australian National Survey of Mental Health and Wellbeing Part II. Relationships between personality disorder, Axis I mental disorders and physical conditions with disability and health consultations. Soc Psychiatry Psychiatr Epidemiol 37:251–260PubMedCrossRef
4.
Coid J, Yang M, Tyrer P, Roberts A, Ullrich S (2006) Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry 188:423–431PubMedCrossRef
5.
Casey PR, Tyrer PJ (1986) Personality, functioning and symptomatology. J Psychiatr Res 20:363–374PubMedCrossRef
6.
Moran P, Jenkins R, Tylee A, Blizard R, Mann A (2000) The prevalence of personality disorder among UK primary care attenders. Acta Psychiatr Scand 102:52–57PubMedCrossRef
7.
Tyrer P, Casey P, Gall J (1983) Relationship between neurosis and personality disorder. Br J Psychiatry 142:404–408PubMedCrossRef
8.
Cutting J, Cowen PJ, Mann AH, Jenkins R (1986) Personality and psychosis: use of the standardized assessment of personality. Acta Psychiatr Scand 73:87–92PubMedCrossRef
9.
Keown P, Holloway F, Kuipers E (2002) The prevalence of personality disorders, psychotic disorders and affective disorders amongst the patients seen by a community mental health team in London. Soc Psychiatry Psychiatr Epidemiol 37:225–229PubMedCrossRef
10.
Newton-Howes G, Tyrer P, Anagnostakis K, Cooper S, Bowden-Jones O, Weaver T, COSMIC study team (2010) The prevalence of personality disorder, its comorbidity with mental state disorders, and its clinical significance in Community Mental Health Teams. Soc Psychiatry Psychiatr Epidemiol 45(4):453–460PubMedCrossRef
11.
Reich J (2003) The effect of axis II disorders on the outcome of treatment of anxiety and unipolar depressive disorders: a review. J Pers Disord 17:387–405PubMedCrossRef
12.
Bender DS, Dolan RT, Skodol AE, Sanislow CA, Dyck IR, McGlashan TH, Shea MT, Zanarini MC, Oldham JM, Gunderson JG (2001) Treatment utilization by patients with personality disorders. Am J Psychiatry 158(2):295–302PubMedCrossRef
13.
Reich J, Boerstler H, Yates W, Nduaguba M (1989) Utilization of medical resources in persons with DSM-III personality disorders in a community sample. Int J Psychiatry Med 19:1–9PubMedCrossRef
14.
Tyrer P, Seivewright H (2000) Studies of outcome. In: Personality disorders: diagnosis, management and course, 2 edn. Butterworth-Heinemann, Oxford, pp 105–125
15.
Dowson JH, Grounds AT (eds) (1995) Personality disorders, recognition and clinical management. Cambridge University Press, Cambridge
16.
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. Text Revision (DSM-IV-TR) Washington
17.
World Health Organisation (1992) The ICD-10 classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines. World Health Organisation, Geneva
18.
Wing JK, Curtis RH, Beevor AS (1996) HoNOS: health of the nation outcome scales. College Research Unit, London
19.
Endicott J, Spitzer RL, Fleiss JL, Cohen J (1976) The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33:766–771PubMedCrossRef
20.
SPSS Inc (2004) SPSS 12.0.2 [Computer software]. SPSS Inc., Chicago
21.
Siegel S, Castellan NJ (1988) Nonparametric statistics for the behavioural sciences, 2nd edn. McGraw-Hill, New York
22.
23.
Kirkbride JB, Fearon P, Morgan C, Dazzan P, Morgan K, Tarrant J et al (2006) Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Arch Gen Psychiatry 63:250–258PubMedCrossRef
24.
Al-Saffar S, Borga P, Wicks S, Hallstrom T (2004) The influence of the patients’ ethnicity, socio-demographic conditions and strain on psychiatric diagnoses given at an outpatient clinic. Nord J Psychiatry 58:421–427PubMedCrossRef
25.
Battle CL, Shea MT, Johnson DM, Yen S, Zlotnick C, Zanarini MC et al (2004) Childhood maltreatment associated with adult personality disorders: findings from the Collaborative Longitudinal Personality Disorders Study. J Pers Disord 18:193–211PubMedCrossRef
26.
Krysinska K, Heller TS, De LD (2006) Suicide and deliberate self-harm in personality disorders. Curr Opin Psychiatry 19:95–101PubMedCrossRef
27.
Read J, van OJ, Morrison AP, Ross CA (2005) Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatr Scand 112:330–350PubMedCrossRef
28.
van der Vegt EJ, van der Ende J, Ferdinand RF, Verhulst FC (2009) Impact of early childhood adversities on adult psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 44(9):724–731PubMedCrossRef
29.
National Institute of Mental Health in England (2003). Personality disorder: no longer a diagnosis of exclusion Department of Health
30.
Mellsop G, Varghese F, Joshua S, Hicks A (1982) The reliability of axis II of DSM-III. Am J Psychiatry 139:1360–1361PubMed
31.
Casey P (2000) The epidemiology of personality disorders. In: Tyrer P (ed) Personality disorders: diagnosis management and course, 2nd edn. Arnold, London, pp 71–79
32.
Tyrer P, Simmonds S (2003) Treatment models for those with severe mental illness and comorbid personality disorder. Br J Psychiatry Suppl 44:S15–S18PubMedCrossRef
33.
Tyrer P, Seivewright N, Ferguson B, Murphy S, Darling C, Brothwell J et al (1990) The Nottingham Study of Neurotic Disorder: relationship between personality status and symptoms. Psychol Med 20:423–431PubMedCrossRef
34.
Skodol AE, Oldham JM, Bender DS, Dyck IR, Stout RL, Morey LC et al (2005) Dimensional representations of DSM-IV personality disorders: relationships to functional impairment. Am J Psychiatry 162:1919–1925PubMedCrossRef
35.
Feigenbaum JD, Fonagy P, Pilling S, Jones A, Wildgoose A, Bebbington PE (2012) A real world study of the effectiveness of DBT in the UK National Health Service. Br J Clin Psychol 51(2):121–141PubMedCrossRef
36.
Bateman AW (2012) Treating borderline personality disorder in clinical practice. Am J Psychiatry 169(6):560–563PubMedCrossRef
37.
Clarke S, Thomas P, James K (2013) Cognitive analytic therapy for personality disorder: randomised controlled trial. Br J Psychiatry 202(2):129–134PubMedCrossRef
Metadata
Title
The impact of a diagnosis of personality disorder on service usage in an adult Community Mental Health Team
Authors
M. Byrne
S. Henagulph
R. J. McIvor
J. Ramsey
J. Carson
Publication date
01-02-2014
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 2/2014
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-013-0746-3

Other articles of this Issue 2/2014

Social Psychiatry and Psychiatric Epidemiology 2/2014 Go to the issue

Original Paper

A prediction model for the incidence of civil detention for crisis patients with psychiatric illnesses; the Amsterdam study of acute psychiatry VII

Original Paper

Community treatment orders: the experiences of Non-Maori and Maori within mainstream and Maori mental health services

Original Paper

Defining multiple criteria for meaningful outcome in routine outcome measurement using the Health of the Nation Outcome Scales

Original Paper

Stressful psychosocial school environment and suicidal ideation in Chinese adolescents

Original Paper

Occupational functioning and work impairment in association with personality disorder trait-scores

Original Paper

The impact of newspaper reporting of hydrogen sulfide suicide on imitative suicide attempts in Japan