Crisis intervention at the general hospital: An appropriate treatment choice for acutely suicidal borderline patients

Berrino, Annamaria; Ohlendorf, P.; Duriaux, Stéphan; Burnand, Yvonne; Lorillard, S.; Andréoli, A.

doi:10.1016/j.psychres.2010.06.018

Cited by 30 publications

(47 citation statements)

References 29 publications

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“…Managed care's pressure for shortened hospital stays has inadvertently benefited the management of hospitalized suicidal individuals with BPD [42]. Alternative possibilities include 1) partial hospitalization, for which empiric data exist supporting efficacy in mentalization-based programming [28,43]; however, accessibility to this type of specialized approach is limited; and 2) crisis intervention unit (CIU) [44]. This alternative to traditional inpatient hospitalization was an eight-bed unit with maximum length of stay of 5 days, with a focus on evaluation and brief interventions.…”

Section: Hospitalizationmentioning

confidence: 99%

Suicidal Risk and Management in Borderline Personality Disorder

Goodman

Roiff

Oakes

et al. 2011

Curr Psychiatry Rep

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This paper reviews recent advances in our understanding of suicidality in borderline personality disorder (BPD), with a focus on suicide risk assessment, guidelines for treatment, and medicolegal concerns. Relevant material on distinctions between suicide completers and suicide attempters, contributions of published American Psychiatric Association Guidelines, the controversial role of hospitalization, and management strategies regarding litigation is addressed. Despite accumulating data on suicidality in BPD, the current state of knowledge offers only partial clues to help identify the BPD patients most at risk of death by suicide, and offers a limited armamentarium of treatment targeted to suicide prevention, creating discomfort in clinicians and fears regarding litigation in the event of a successful suicide. Promising new interventions include less resource-intensive psychotherapies as well as brief crisis intervention.

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Section: Hospitalizationmentioning

confidence: 99%

Suicidal Risk and Management in Borderline Personality Disorder

Goodman

Roiff

Oakes

et al. 2011

Curr Psychiatry Rep

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“…For example, consumers reported improved ability to cope outside of hospital post-discharge. Similarly, Berrino et al (2011) found that crisis intervention consisting of approximately 5 days at a general hospital reduced incidents of self-harm and psychiatric hospitalisation during the 3 month follow-up period, compared with the treatment-as-usual group. These studies are important as they indicate that it is the brief admission itself that is effective, rather than the environment.…”

Section: Adaptations Of Hospitalisation-based Interventionsmentioning

confidence: 87%

Recovery and Borderline Personality Disorder: A Description of the Innovative Open Borders Program

Mortimer-Jones

Morrison

Munib

et al. 2016

Issues in Mental Health Nursing

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Although Recovery-oriented approaches to delivering mental health services are now promoted in health services across the globe, there is an ongoing need to adapt these approaches to meet the unique needs of consumers with a diagnosis of borderline personality disorder. The lived experience of borderline personality disorder includes emotional dysregulation, intense and unstable relationships, self-harming behaviours, fear of abandonment, and a limited capacity to cope with stress. These experiences present a range of challenges for those who deliver Recovery-oriented services and advocate the principles of empowerment and self-determination. This paper describes a novel crisis intervention program, "Open Borders," which has been established to meet the unique needs of people with a borderline personality disorder diagnosis. Open Borders is a Recovery-oriented model that is run at a public, state-wide residential facility for mental health consumers in Western Australia, and offers alternative pathways to achieving mental health Recovery, including self-referral and short-term admission to a residential facility. The aims of the program are to break the cycle of hospital admission, reduce rates of self-harm, and support the complex Recovery journey of consumers with a diagnosis of borderline personality disorder. Open Borders provides an exemplar for other health service organisations seeking to establish Recovery-oriented crisis intervention alternatives.

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“…Two psychiatrists and three clinical psychologists, ranging in age from 35 to 61, who had all completed structured training in psychodynamic psychotherapy and who had considerable psychotherapy experience, delivered AP-P. AP-N was delivered by eight nurses aged 31-54 who had extensive crisis intervention experience with depressed and borderline patients (Berrino et al, 2011;Burnand et al, 2002). The nurses had been previously rated from good to very good on an instrument assessing quality of therapeutic skill with borderline patients (Andreoli et al, 2000).…”

Section: Treatments and Therapistsmentioning

confidence: 99%

“…To substantiate the economic interest of testing AP and comparing AP-P and AP-N, an expected direct cost was calculated a priori for each treatment using previous studies (Berrino et al, 2011;Rosset & Andreoli, 1995). These estimated costs were: AP-P: 8,280SF (5,520 euros); AP-N: 4,260 SF (2,840 euros); TAU: 15,750 SF (10,500 euros) (mean exchange rate vs. $ and £: 0.92 and 1.53).…”

Section: Treatments and Therapistsmentioning

confidence: 99%

“…Finally, we compared the efficacy of abandonment psychotherapy delivered by boarded psychotherapists versus experienced nurses without structured psychotherapy training. In previous articles, we showed that simple psychotherapeutic interventions delivered by well-trained, carefully supervised nurses were cost-effective among depressed patients with severe personality psychopathology (Burnand, Andreoli, Kolatte, Venturini, & Rosset, 2002) and among patients referred to the ER with BPD and deliberate self-harm (Berrino et al, 2011). In times of reduced funding, such interventions are less expensive and may provide a valuable alternative to psychotherapy delivered by boarded psychotherapists.…”

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confidence: 99%

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Disappointed Love and Suicide: A Randomized Controlled Trial of “Abandonment Psychotherapy” Among Borderline Patients

Andréoli

Burnand

Cochennec

et al. 2016

Journal of Personality Disorders

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To determine whether ambulatory psychotherapy targeted to abandonment experiences and fears can reduce suicidality and improve outcome in borderline patients referred to the emergency room with major depressive disorder and self-destructive behavior severe enough to require medical/ surgical treatment and a brief psychiatric hospitalization. A total of 170 subjects were randomized at hospital discharge into three treatment groups: treatment as usual (TAU), abandonment psychotherapy delivered by certified psychotherapists, and abandonment psychotherapy delivered by nurses. Assessments were performed before randomization and at 3-month followup. Continued suicidality and other outcome measures were significantly worse in the treatment-as-usual as compared to both abandonment psychotherapy groups, but there were no differences between the two psychotherapy groups. These results suggest the efficacy of manualized psychotherapy that specifically targets the abandonment fears and experiences that are so common as precipitants to suicidal and self-destructive acts in borderline patients. It does not appear that formal psychotherapy training is associated with better outcomes.

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Crisis intervention at the general hospital: An appropriate treatment choice for acutely suicidal borderline patients

Cited by 30 publications

References 29 publications

Suicidal Risk and Management in Borderline Personality Disorder

Suicidal Risk and Management in Borderline Personality Disorder

Recovery and Borderline Personality Disorder: A Description of the Innovative Open Borders Program

Disappointed Love and Suicide: A Randomized Controlled Trial of “Abandonment Psychotherapy” Among Borderline Patients

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