A proposed clinical pathway for the patients with Borderline Personality Disorder presenting to Emergency Departments.

OBJECTIVE: Emergency Department (ED) care of repeated self-injury, intensive affective lability, and interpersonal dysfunction associated with borderline personality disorder (BPD) is challenging. We propose an evidence-based acute clinical pathway for people with BPD. CONCLUSION: Our standardised evidence-based short-term acute hospital treatment pathway includes structured ED assessment, structured short-term hospital admission when clinically indicated, and immediate short-term (4-sessions) clinical follow-up. This approach could be adopted nationally to reduce iatrogenic harm, acute service overdependence and negative healthcare system impacts of BPD.

Determining the Influence of Psychiatric Comorbidity on Hospital Admissions in Cardiac Patients Through Multilevel Modelling of a Large Hospital Activity Data Set.

BACKGROUND: Increasingly, big data derived from administrative hospital records can be subject to analytics to provide clinical insights. The aim of this study was to determine the impact of psychiatric comorbidity on length of hospital stay and number of hospital admissions in cardiac patients utilising routinely collected hospitalisation records. METHODS: We routinely collected clinical and socio-demographic variables extracted from 37,580 cardiac patients, between 18 and 65 years old, admitted to South Australian hospitals between 2001/02 to 2010/11 financial years with cardiac diagnoses used to derive patient level and separation level variables used in the modelling. Multi-level models were constructed to analyse the impact of psychiatric comorbidity on both length of stay and the total number of hospitalisations, allowing for interactions between socioeconomic status and the burden of disease. Possible confounders for these models were, sex, age, indigenous status, country of birth, and rural status. RESULTS: For cardiac patients a mental health diagnosis was associated with an increase of 12.5% in the length of stay, and an increase in the number of stays by 20.0%. CONCLUSIONS: This study demonstrates the potential utility of routinely collected hospitalisation records to demonstrate the impact of psychiatric comorbidity on health service utilisation.

Psychodynamic therapy for non-compliance: a case report.

OBJECTIVES: This paper outlines the use of psychodynamic psychotherapy as an adjunct to treatment as usual for addressing challenging behaviours in a patient with schizophrenia under the care of a community mental health team (CMHT) in South Australia. METHODS: Ms P suffered from schizophrenia and demonstrated challenging behaviours in the context of being administered depot medication under a community treatment order (CTO). Multiple attempts at addressing non-compliance and consistently disruptive behaviour through conventional methods had failed. Consequently, the novel approach of fortnightly psychodynamic psychotherapy sessions was trialled for 5 months, augmenting treatment as usual. RESULTS: Psychodynamic psychotherapy proved effective for this patient. With treatment, she showed an improved compliance and overall engagement. Additionally, consequent to regularly receiving medication, her mental state improved and hospitalisations decreased. CONCLUSIONS: Further research could lead to a better understanding of how and in what contexts, psychodynamic therapy and psychodynamic thinking can be utilised in the public health system.

Successful clozapine re-challenge following myocarditis.

OBJECTIVE: To explore the evidence around clozapine re-challenge following myocarditis. CONCLUSION: This case adds to the 17 cases of clozapine re-challenge following myocarditis, of which 71% were successful (12 cases). This demonstrates that re-challenge could be performed safely and effectively in the context of clozapine-induced myocarditis, if accompanied by a strict and rigorous monitoring protocol.