Working with people diagnosed with Personality Disorder

Transcription

1 Working with people diagnosed with Personality Disorder 4 October 2018 Ioanna Xenophontes, Lived Experience Practitioner, Bromley ADAPT Dr Laura Allison, Locum Consultant Psychiatrist in Psychotherapy Dr Neil Springham, Head of Arts Therapies and Lead for Psychological Therapies

2 Programme for the evening 7 pm an overview of personality disorder and some theories 8 pm 10 minute tea break 8.10 pm systems and service interactions 8.30 pm questions and discussion 9 pm close 2

3 What is the problem we are trying to solve? Personality Long-standing Personality Disorder ICD-10 (WHO) markedly disharmonious attitudes and behaviour, involving several areas of functioning; enduring and not limited to episodes of mental illness; pervasive to a broad range of personal and social situations; appear during childhood or adolescence and continue into adulthood; leads to considerable personal distress; usually, but not invariable, associated with significant problems in occupational and social performance. 3

4 How common is it? 1 in

5 Aetiology Environment Organic Genes Predisposing, Precipitating and Perpetuating factors 5

6 Ioanna s story 6

7 Duration of crisis improves before intensity of crisis 7

8 Some theories Bowlby - Attachment theories. Balint early ego distortions which persist and are repeated. Kernberg emphasises role of early deprivation (i.e. before the age of 2). Focus on developing ego strengths by confronting the patient s need to control. Kohut emphasises the patient s need to adapt to reality, and psychological growth, by using regression. Cognitive Theory focuses on re-evaluating cognitions around interactions, for example, and developing problemfocused coping strategies (used in the SUN project). 8

9 NICE BPD guidelines overview Develop a trusting relationship and manage transitions. Training and support for professionals (including burnout in 2 nd MH teams). Primary Care early identification and referral to 2 nd MH. Secondary MH: psychological, social care and occupational development. Risk differentiate long term and more immediate risk (especially relationship changes). Psychological Therapy: not less than 3 months+ 2 x per week. Medication: No meds for BPD, but for associated symptoms. Not use anti-psychotic mid-long term 9

10 Questions. What do the NICE guidelines not capture about the reality of your practice? 10

11 Therapies and interventions - common mechanisms Small to moderate effect size differences between types of treatment at treatment termination, which largely disappear at follow up Cristea, A., Gentili, C., Cotet, C., Palomba, D., Barbui, C., & Ciujposs, P. (2017) Efficacy of psychotherapy for BPD: a systematic review and meta analysis. JAMA Psychiatry 74, Approaches which utilises common factors allows interdisciplinary/inter-agency working Bateman, A., Campbell, C., Lutyen, P., & Fonagy P. (2018) A mentalization-based approach to common factors in the therapeutic treatment of BPD. Science Direct, Where therapies work, they work in the same way via: - Validation - Consistency 11

12 John Bowlby and Mary Ainsworth - Attachment theory Idea of a secure base from which to explore. Disruption early in childhood can result in lasting relationship difficulties. Patterns of attachment are repeated in relationships, the clinician-patient relationship being one of them. Attachment patterns can be repeated intergenerationally, but they don t have to be. 12

13 Attachment theory and the still face experiment 13

14 10 minute break 14

15 Working together: consistent and validating Single Point of Entry for mental health (Oxleas/Mind/IAPT). Shared care and assisted self-management. 15

16 Impact of SUN groups early findings Jones, Juett and Hill; (2014): SUN model in SWLSTG resulted in: 50% reduction in bed use, 3 months postcommencement of SUN; 85% reduction in ED attendances in mental health crisis; 60% reduction in GP attendances. 16

17 Impact on ED attendance Bromley 60 No of A&E presentations 3 months pre and post 1st SUN group attendance (N=50 ) Number of A&E presentations pre number of A&E presentations post 17

18 Impact on HTT episodes - Bromley 90 No of HTT episodes 3 months pre and post 1st SUN group (N= 50)

19 Impact on admissions Bromley, 6 months 18 Number of admissions 6 months pre and post 1st SUN group (N=34)

20 Impact on HTT episodes Bromley, 6 months 70 Number of HTT episodes 6 months pre and post first SUN group Series HTT epidose pre HTT epsiodes post 20

21 Impact on admissions bed days Bromley, 6 months 400 Total no of bed days 6 months pre and post 1st SUN group attendance (N=34)

22 Ioanna Xenophontes, Lived Experience Practitioner, Bromley ADAPT Tel: Dr Laura Allison, Locum Consultant Psychiatrist in Psychotherapy Tel: Dr Neil Springham, Head of Arts Therapies and Lead for Psychological Therapies Tel: