Evidence of practice gaps in emergency psychiatric care for borderline personality disorder: how can this be explained?
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RESEARCH ARTICLE
Open Access
Evidence of practice gaps in emergency psychiatric care for borderline personality disorder: how can this be explained? Cécile Cases1, Stéphanie Lafont Rapnouil1, Adeline Gallini2,3, Christophe Arbus1,4,5 and Juliette Salles1,5,6,7*
Abstract Background: Recent research has highlighted that patients with borderline personality disorder (BPD) could experience symptomatic remissions. This led to the production of guidelines concerning the most appropriate care. In addition, as BPD patients frequently present at an emergency department (ED), specific recommendations concerning how they should be cared for there have also been developed. The recommendations include the referral of patients to inpatient, outpatient or specific crisis care. However, an issue that has not been addressed is the capacity of ED services to apply the care recommendations. The objective of our study, therefore, was to identify the factors limiting their use in the ED of Toulouse University Hospital. Methods: A panel of psychiatrists specializing in BPD care examined the medical files of 298 patients with a BPD diagnosis to determine which referrals were consistent or not, according to the care recommendations. A logistic regression was then performed to identify which sociodemographic, clinical, organizational or professional-training factors were associated with inconsistent referrals. Results: 32% of patients experienced an inconsistent referral. Consultations performed during an on-call or day-off schedule were linked with inconsistent referrals, while an active follow-up was associated with the provision of consistent care. Conclusion: Changing how evaluations of BPD patients in the ED are organized during on-call and day-off schedules could improve the application of the care recommendations regarding the most appropriate referrals. Keywords: Borderline personality disorder, Care recommendations, Emergency department
Background Borderline personality disorder (BPD) is a common psychiatric diagnosis, with a prevalence of 1 to 2% in the general population and 10 and 20% in the psychiatric out and inpatient populations, respectively [1, 2]. Historically, BPD was considered to be a chronic and debilitating condition that was less susceptible to improvement * Correspondence: [email protected] 1 CHU Toulouse, Service de psychiatrie et psychologie, psychiatrie, F-31000 Toulouse, France 5 Institut des Handicaps Neurologiques, Psychiatriques et Sensoriels- CHU de Toulouse, F-31000 Toulouse, France Full list of author information is available at the end of the article
than other psychiatric disorders. This conception was, however, revised following longitudinal research over the last 4 years which demonstrated that the evolution of BPD is more complex. In particular, it was shown that symptomatic remissions, defined as the presence of less than two symptoms [3], are common in these patients. Indeed, remission was achieved in 25% of patients for 2 years [4]. Moreover, after 10 years of patient follow-ups, re
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