Rapid tranquillisation for psychiatric in-patients with a diagnosis of personality disorder: under-recognised issue

TL;DR

The paper highlights that women with personality disorders in psychiatric hospitals often experience acute behavioral episodes involving self-harm, leading to frequent use of rapid tranquillisation.

Contribution

The study provides new insights into the under-recognized issue of managing acute behavioral episodes in female psychiatric in-patients with personality disorders.

Findings

Episodes of acutely disturbed behavior occurred in 951 patients, with 82% involving female patients.

Females were three times more likely to exhibit self-harming behavior or risk compared to males.

Rapid tranquillisation was administered twice as often in female patients compared to males.

Abstract

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.

To explore the clinical characteristics and management of episodes of acutely disturbed behaviour requiring medication in in-patients with a diagnosis of personality disorder.

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.

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).

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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