Rapid tranquillisation for psychiatric in-patients with a diagnosis of personality disorder: under-recognised issue
Background Clinical guidelines for personality disorder emphasise the importance of patients being supported to develop psychological skills to help them manage their symptoms and behaviours. But where these mechanisms fail, and hospital admission occurs, little is known about how episodes of acut...
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Cambridge University Press
2025-09-01
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| Series: | BJPsych Open |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2056472425100525/type/journal_article |
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| author | Carol Paton Mike J. Crawford Matthew Hartley Clive E. Adams Elena M. Edokpolor Pernia Olivia Rendora Thomas R. E. Barnes |
| author_facet | Carol Paton Mike J. Crawford Matthew Hartley Clive E. Adams Elena M. Edokpolor Pernia Olivia Rendora Thomas R. E. Barnes |
| author_sort | Carol Paton |
| collection | DOAJ |
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Background
Clinical guidelines for personality disorder emphasise the importance of patients being supported to develop psychological skills to help them manage their symptoms and behaviours. But where these mechanisms fail, and hospital admission occurs, little is known about how episodes of acutely disturbed behaviour are managed.
Aims
To explore the clinical characteristics and management of episodes of acutely disturbed behaviour requiring medication in in-patients with a diagnosis of personality disorder.
Method
Analysis of clinical audit data collected in 2024 by the Prescribing Observatory for Mental Health, as part of a quality improvement programme addressing the pharmacological management of acutely disturbed behaviour. Data were collected from clinical records using a bespoke proforma.
Results
Sixty-two mental health Trusts submitted data on 951 episodes of acutely disturbed behaviour involving patients with a personality disorder, with this being the sole psychiatric diagnosis in 471 (50%). Of the total, 782 (82%) episodes occurred in female patients. Compared with males, episodes in females were three times more likely to involve self-harming behaviour or be considered to pose such a risk (22% and 70% respectively: p < 0.001). Parenteral medication (rapid tranquillisation) was administered twice as often in episodes involving females than in males (64 and 34% respectively: p < 0.001).
Conclusions
Our findings suggest that there are a large number of episodes of acutely disturbed behaviour on psychiatric wards in women with a diagnosis of personality disorder. These episodes are characterised by self-harm and regularly prompt the administration of rapid tranquillisation. This has potential implications for service design, staff training, and research.
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| format | Article |
| id | doaj-art-2d936a2b2f4445a08ffadd088dbf03cf |
| institution | DOAJ |
| issn | 2056-4724 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj-art-2d936a2b2f4445a08ffadd088dbf03cf2025-08-20T02:47:28ZengCambridge University PressBJPsych Open2056-47242025-09-011110.1192/bjo.2025.10052Rapid tranquillisation for psychiatric in-patients with a diagnosis of personality disorder: under-recognised issueCarol Paton0https://orcid.org/0000-0001-7756-1031Mike J. Crawford1https://orcid.org/0000-0003-3137-5772Matthew Hartley2https://orcid.org/0000-0003-2522-7781Clive E. Adams3https://orcid.org/0000-0003-1628-4020Elena M. Edokpolor Pernia4https://orcid.org/0009-0000-8903-3201Olivia Rendora5https://orcid.org/0000-0002-7843-3426Thomas R. E. Barnes6https://orcid.org/0000-0002-2324-656XPrescribing Observatory for Mental Health, Royal College of Psychiatrists, London, UK Division of Psychiatry, Imperial College London, London, UKDivision of Psychiatry, Imperial College London, London, UKBehavioural & Developmental Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UKMental Health Services Research. University of Nottingham, Nottingham, UKPrescribing Observatory for Mental Health, Royal College of Psychiatrists, London, UKPrescribing Observatory for Mental Health, Royal College of Psychiatrists, London, UKPrescribing Observatory for Mental Health, Royal College of Psychiatrists, London, UK Division of Psychiatry, Imperial College London, London, UK Background Clinical guidelines for personality disorder emphasise the importance of patients being supported to develop psychological skills to help them manage their symptoms and behaviours. But where these mechanisms fail, and hospital admission occurs, little is known about how episodes of acutely disturbed behaviour are managed. Aims To explore the clinical characteristics and management of episodes of acutely disturbed behaviour requiring medication in in-patients with a diagnosis of personality disorder. Method Analysis of clinical audit data collected in 2024 by the Prescribing Observatory for Mental Health, as part of a quality improvement programme addressing the pharmacological management of acutely disturbed behaviour. Data were collected from clinical records using a bespoke proforma. Results Sixty-two mental health Trusts submitted data on 951 episodes of acutely disturbed behaviour involving patients with a personality disorder, with this being the sole psychiatric diagnosis in 471 (50%). Of the total, 782 (82%) episodes occurred in female patients. Compared with males, episodes in females were three times more likely to involve self-harming behaviour or be considered to pose such a risk (22% and 70% respectively: p < 0.001). Parenteral medication (rapid tranquillisation) was administered twice as often in episodes involving females than in males (64 and 34% respectively: p < 0.001). Conclusions Our findings suggest that there are a large number of episodes of acutely disturbed behaviour on psychiatric wards in women with a diagnosis of personality disorder. These episodes are characterised by self-harm and regularly prompt the administration of rapid tranquillisation. This has potential implications for service design, staff training, and research. https://www.cambridge.org/core/product/identifier/S2056472425100525/type/journal_articlePersonality disorderacutely disturbed behaviourrapid tranquillisationself-harm |
| spellingShingle | Carol Paton Mike J. Crawford Matthew Hartley Clive E. Adams Elena M. Edokpolor Pernia Olivia Rendora Thomas R. E. Barnes Rapid tranquillisation for psychiatric in-patients with a diagnosis of personality disorder: under-recognised issue BJPsych Open Personality disorder acutely disturbed behaviour rapid tranquillisation self-harm |
| title | Rapid tranquillisation for psychiatric in-patients with a diagnosis of personality disorder: under-recognised issue |
| title_full | Rapid tranquillisation for psychiatric in-patients with a diagnosis of personality disorder: under-recognised issue |
| title_fullStr | Rapid tranquillisation for psychiatric in-patients with a diagnosis of personality disorder: under-recognised issue |
| title_full_unstemmed | Rapid tranquillisation for psychiatric in-patients with a diagnosis of personality disorder: under-recognised issue |
| title_short | Rapid tranquillisation for psychiatric in-patients with a diagnosis of personality disorder: under-recognised issue |
| title_sort | rapid tranquillisation for psychiatric in patients with a diagnosis of personality disorder under recognised issue |
| topic | Personality disorder acutely disturbed behaviour rapid tranquillisation self-harm |
| url | https://www.cambridge.org/core/product/identifier/S2056472425100525/type/journal_article |
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