Treatment of Severe Emotionally Unstable Personality Disorder with Comorbid Ehlers-Danlos Syndrome and Functional Neurological Disorder in an Inpatient Setting: A Case for Specialist Units without Restrictive Interventions.

We present the case of a young woman with an Emotionally Unstable Personality Disorder (EUPD) diagnosis suffering from high-risk self-injurious behaviour. She was also diagnosed with Ehlers-Danlos Syndrome and Functional Neurological Disorder, manifesting as nonepileptic seizures and immobility. Our patient, "A," endured traumatic childhood abuse and became highly dependent on services in her late teens. Recurrent suicide attempts resulted in twenty to thirty acute psychiatric admissions, Intensive Care Unit stays, and multiple failed trials of psychological therapy. Nonepileptic seizures and wheelchair dependency made her "too complex" for many specialist services. She was eventually admitted to Springbank ward in Fulbourn Hospital, Cambridge. The EUPD specialist unit prides itself on evidence-based treatments, shared values, and a least restrictive approach. At discharge, our patient was self-harm free and able to walk unaided and no longer met EUPD diagnostic criteria. We include "A's" personal views on her illness and how Springbank ward facilitated her recovery, together with results from structured clinical outcome measures.

Control and restraint training in acute mental health care.

AIM: This article describes the first stage of a research project. The aim was to establish the frequency and pattern of assault, and the use, effectiveness and safety of breakaway and restraint techniques, in an intensive care unit for mental health patients. Views of nursing staff with regard to training and the use of restraint were also explored. METHOD: The study involved a qualitative analysis of 346 adverse incident reports in a 16-bed mental health intensive care unit over a 32-month period. Data on staff perceptions of breakaway and restraint techniques were collected using face-to-face, semi-structured interviews with 19 nurses. RESULTS: Of the 85 incidents identified, 11 were attempted assaults intended to cause physical harm to a member of staff. The remaining 74 involved actual contact with a client or an object held or thrown by him or her. Punches and kicks were the most common forms of assault reported. There were 66 incidents of restraint recorded. The most common reason for this was attack or attempted attack on a member of staff. CONCLUSION: Staff were generally satisfied with the training they received on control and restraint courses, however some problems were identified. There appears to be a mismatch between patterns of assault and preparation for dealing with assaults. Aspects of restraint, such as establishment of holds, are problematic in application. Although punches and kicks were the most common form of assault reported, less time is spent on these during training.