BPD and hospitalization...

Connection between borderline personality and hospitalization. What a good question, we could say. I don't know if there is a lot a study, and I really don't know if the answers could be in some studies. You will find on the last part of this document our vision which we hope comprehensive and listening to the suffering

* 15 to 20% of the individuals hospitalized in psychiatry (inpatients) have a borderline personality disorder (apa)

* Paris J. - The Department of Psychiatry at McGill University..., Montreal, Canada.
2OO4 J Personal Disord. - Is hospitalization useful for suicidal patients with borderline personality disorder?
This article examines the value of hospitalization for chronically suicidal patients with borderline personality disorder (BPD). One in 10 of these patients will eventually complete suicide. However, this outcome is not readily predictable. Hospitalization is of unproven value for suicide prevention and can often produce negative effects. Day treatment is an evidence-based alternative to full admission. Chronic suicidality can best be managed in an outpatient setting.

* Bateman A, Fonagy P. - Halliwick Day Unit, St. Ann's Hospital, London UK
2OO3 Am J Psychiatry. - Health service utilization costs for borderline personality disorder patients treated with psychoanalytically oriented partial hospitalization versus general psychiatric care.
Costs were compared for the 6 months before treatment, 18 months of treatment, and an 18-month follow-up period.
Conclusion: Specialist partial hospital treatment for borderline personality disorder is no more expensive than treatment as usual and shows considerable cost savings after treatment

* Bateman A, Fonagy P. - Halliwick Day Unit, St. Ann's Hospital.
1999 Am J Psychiatry 1999 - Effectiveness of partial hospitalization in the treatment of borderline personality disorder: a randomized controlled trial.
This study compared the effectiveness of psychoanalytically oriented partial hospitalization with standard psychiatric care for patients with borderline personality disorder
CONCLUSIONS: Psychoanalytically oriented partial hospitalization is superior to standard psychiatric care for patients with borderline personality disorder. Replication is needed with larger groups, but these results suggest that partial hospitalization may offer an alternative to inpatient treatment.

* Morissette L, Parisien M. - Institut Philippe Pinel de Montreal.
1997 Sante Ment Que. - The hospital's contribution to the treatment of patients with borderline personality disorders
Borderline patients, because of their symptomatology are frequent users of health care services (mental and physical). A recent review of the literature shows that the authors of this article favor a treatment within the community that should be eclectic, on a long-term basis and with varied intensity. The hospital is part of the therapeutic tools available for the treatment of these patients and should serve to contain crisis, specify diagnosis and to prepare and reinforce a rapid return in their community. Exceptionally, a prolonged hospitalization (> 6 months) would be indicated especially for adolescents

"Sometimes the crisis is so severe that short-term hospitalization is needed. Often it is only after a short-term hospitalization that the diagnosis of Borderline Personality Disorder can be accurately made" (Phillip W. Long, M.D. ,“Borderline Personality Disorder: Treatment”, www.mentalhealth.com 1997)

"Brief hospitalization may sometimes be necessary during acutely stressful episodes or if suicide or other self-destructive behavior threatens to erupt. Hospitalization may provide a a temporary removal from external stress." (Richard J. Corelli, M.D ,“Borderline Personality Disorders”, stanford university CA)

"When the patient is extremely suicidal, hospitalization is necessary, but most patients with BPD can do well with a structured outpatient program involving individual and group therapy and medication" (Glen O. Gabbard, M.D.,“Discusses Borderline Personality Disorder“,Baylor College of Medicine)

"Hospitalization may be required during periods of acute decompensation to prevent self-destructive behaviors and to stabilize the patient, although it has not been shown to prevent suicide in this population" (Kathi Stringer, “About Borderline Personality Disorder”, www.toddlertime.com)

"Indications for partial hospitalization include the following:

• Dangerous, impulsive behavior unable to be managed with outpatient treatment
• Nonadherence with outpatient treatment and a deteriorating clinical picture
• Complex comorbidity that requires more intensive clinical assessment of response to treatment
• Symptoms of sufficient severity to interfere with functioning, work, or family life that are unresponsive to outpatient treatment

Indications for brief inpatient hospitalization include the following:

• Imminent danger to others
• Loss of control of suicidal impulses or serious suicide attempt
• Transient psychotic episodes associated with loss of impulse control or impaired judgment
• Symptoms of sufficient severity to interfere with functioning, work, or family life that are unresponsive to outpatient treatment and partial hospitalization

Indications for extended inpatient hospitalization include the following:

• Persistent and severe suicidality, self-destructiveness, or nonadherence to outpatient treatment or partial hospitalization
• Comorbid refractory axis I disorder (e.g., eating disorder, mood disorder) that presents a potential threat to life
• Comorbid substance abuse or dependence that is severe and unresponsive to outpatient treatment or partial hospitalization
• Continued risk of assaultive behavior toward others despite brief hospitalization
• Symptoms of sufficient severity to interfere with functioning, work, or family life that are unresponsive to outpatient treatment, partial hospitalization, and brief hospitalization" (119. American Psychiatric Association, “Practice Guideline for the Treatment of Patients With Borderline Personality Disorder”, book2 www.psych.org 2OO3)

Here is our feeling.

Hospitalization is a very very very sensitive question
First of all remember that the BPD people is primary a person. And each person is different. We can't say "it was good for him / her, so it will be good for you"

Please, remind too, that borderline peoples are NOT psychotic (psychotics event are transient and could be seen as "panic attack") (please read dissociation / multiple personnalities) (of course, they can also have a comorbid illness)

There are some "good" reasons to ... and some to don't

Some "good" reasons

• Protect the patient against him (and also prevent him to hurt somebody else)
It is our duty to save everyone in a big distress
• Extract the patient from his / her home, work environment (to prevent interaction) (especially if there is some kind of physical or psychological abuse)
• To get to the patient, the possibility to have only one concern, his / her health (and not where / how to eat, sleep, pay the bills, ...)

Some "bad" reasons

• Acting against his / her will.  If the hospitalization is not vital, and if the patient doesn't want to, the result will be that the patient will be totally not cooperative. It is then almost impossible to make "GOOD" therapy in such conditions. So before a necessary hospitalization, the best way is to convince not to force  !
When it is not to save life(s), it is a patient's choice
• Because it is more "simple" for the family. When he / she is at the hospital, everybody is more relaxed, we can sleep without dreading a tragedy. If it is the first reason, then we have no more the right to say "it is for his / her own good"
When we "place" a patient in an hospital it is for him first
• In some unacceptable cases, the patient will be in contact with schizophrenic peoples, "crazy" people, and it is a very traumatic experience
We don't mix BPD patients with serious psychiatric peoples
• In some cases, the patient will have too much drugs. These drugs could lead to panic attack, schizophrenic behaviors, and to feel like a "zombie"
BPD people are not crazy, they are sick !

Our resume could be

• Save lifes
• Convince, convince, convince that there is some hope, some future...

Why ? Because it is more effective