Management of 201 individuals with emotionally unstable personality disorders: A naturalistic observational study in real-world inpatient setting.

BACKGROUND: Emotionally unstable personality disorder (EUPD) is a challenging condition with a prevalence of 20% in inpatient services. Psychotherapy is the preferred treatment; nevertheless, off-license medications are widely used. OBJECTIVES: To identify socio-demographics, clinical and service-delivery characteristics of people with EUPD admitted to inpatient services between 1st January 2017 and 31st December 2018. METHODS: A retrospective review using data from patients' records. Individuals, age 18-65 were included. Statistical analysis was conducted by the Mann-Whitney-Wilcoxon test and Chi-squared test with Yates's continuity correction. RESULTS: Of 1646 inpatients, 201 (12.2%); had the diagnosis of EUPD; 133 (66.0%) women, 68 (44.0%). EUPD was significantly (P < .001) more prevalent in women (18.2%) than men (7.4%). EUPD patients were significantly (P < .001) younger (32.2 years) than patients without EUPD (46 years), and had significantly (P < .001) more admissions (1.74) than patients without EUPD (1.2 admission). 70.5% of patients had one and 17.0% two Axis-I psychiatric co-morbidities. Substance use was significantly (P < .001) more often in men (57.3%) than in women (28.5%). Significantly (P = 0.047) more women (68.4%) than men (53.0%) reported sexual abuse. 87.5% used polypharmacy. Antidepressants were significantly (P = 0.02) often prescribed to women (76.6%) than men (69.1%). Significantly (P = 0.02) more women (83.5%) than men (67.6%) were on antipsychotics. 57.2% of the patients were on anxiolytics, 40.0% on hypnotics and 25.8% on mood stabilisers. CONCLUSION: EUPD is a complex condition with widespread comorbidity. The term EUPD, Borderline Personality Disorder is unsuitable, stigmatising and too simplistic to reflect the nature, gravity and psychopathology of this syndrome.

Anti-voltage-gated potassium channel complex antibody-mediated limbic encephalitis: a case report of a 53-year-old man admitted to intensive care psychiatric unit with psychotic mania.

Limbic encephalitis represents a cluster of autoimmune disorders, with inflammation in the medial temporal lobe characterised by subacute onset of neuropsychiatric symptoms such as anxiety, affective symptoms, psychosis, short-term memory impairment as well as faciobrachial and grand mal seizures. We aim to present a case of a 53-year-old man with positive anti-voltage-gated potassium channel (VGKC) complex antibodies who initially presented with symptoms of psychotic mania. Six weeks post-psychiatric symptomatology, he presented with neurological symptoms such as faciobrachial jerking and tonic-clonic seizure. The patient had no previous psychiatric history and was initially treated with psychotropic medications. Our experience emphasises the fact that limbic encephalitis is not easy to identify as most patients initially present with psychiatric symptomatology than neurological symptoms. Furthermore, immunological and laboratory testing takes a rather long time to determine the diagnosis. What is more, few psychiatrists consider autoimmune nature of the neuropsychiatric presentation. Therefore, it is important to consider autoimmune encephalitis in patients with new-onset psychosis or mania who also present with neurological symptoms at some stage of their illness. Characteristic indicators of autoimmune encephalitis include neurological symptoms such as facial twitching, seizures, confusion and cognitive decline.