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

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 case­control 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.

Impact of childbirth on a series of schizophrenic mothers: a comment on the possible influence of oestrogen on schizophrenia.

From a series of 180 admissions to a Mother-Baby Unit 45 patients with diagnoses of schizophrenia were identified. Demographic data together with clinical information were noted, and each file was rated using the OPCRIT programme. Two mutually exclusive groups were derived from OPCRIT, a 'narrow group' (n = 16), corresponding to subjects satisfying Feighner's criteria for schizophrenia, and a 'broad group' (n = 21), corresponding to those meeting ICD10 but not Feighner criteria. In addition to significant differences in age on admission, employment, home circumstances, ethnicity and age of onset of illness, there was a marked contrast between broad and narrow groups in course of illness post partum. 43% of the broad group experienced an acute illness episode after delivery compared with none of the narrow group, a contrast not attributable to differences in clinical state or treatment during pregnancy. These data suggests that childbirth may exert a differential effect on the course of illness in severe and more benign forms of schizophrenia, and that more severe schizophrenic illnesses may not be influenced by the changes associated with childbirth, such as the fall in oestrogen levels.

Assessment and treatment approaches for survivors of torture.

BACKGROUND: Torture, with its personal, cultural, political and psychosocial effects, is presented as a complex trauma. The efficacy of different treatment modalities for those survivors who need assistance is examined critically. METHOD: International literature searches using MEDLINE and Psych-Info, books and relevant book chapters were examined. RESULTS: One hundred and twenty-five articles were selected for analysis; 30 of the most relevant are discussed. CONCLUSIONS: Discrete approaches to treatment have been developed, but many have yet to be evaluated critically. Common therapeutic elements are outlined. It is recommended that an integrated, flexible, client-centred approach utilising several techniques is most likely to achieve best results. Wider socio-political aspects should be taken into account, and treatment must be consistent with cultural expectations. Future directions for research are outlined and the role of primary prevention is stressed.

Drug treatment in post-traumatic stress disorder.

As our knowledge of post-traumatic stress disorder grows, so new treatment strategies develop. This article evaluates the benefits and limitations of drug treatment, with reference to underlying neurobiological changes seen in the condition. Drug treatment has a beneficial role if used as part of a flexible, client-centred approach.