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The relative burden and risk of readmission for people with personality disorders in hospital settings is unknown.
To compare hospital use of people with personality disorder with that of people with other mental health diagnoses, such as psychoses and affective disorders.
Naturalistic study of hospital presentations for mental health in a large community catchment. Mixed-effects Cox regression and survival curves were generated to examine risk of readmission for each group.
Of 2894 people presenting to hospital, patients with personality disorder represented 20.5% of emergency and 26.6% of in-patients. Patients with personality disorder or psychoses were 2.3 times (95% CI 1.79–2.99) more likely than others to re-present within 28 days. Personality disorder diagnosis increases rate of readmission by a factor of 8.7 (s.e. = 0.31), marginally lower than psychotic disorders (10.02, s.e. = 0.31).
Personality disorders place significant demands on in-patient and emergency departments, similar to that of psychoses in terms of presentation and risk of readmission.
The goal of supportive-expressive (SE) psychotherapy is to help the client achieve mastery over their difficulties, gain self-understanding, and practice self-control over habitual drug use and related problems. The theory behind the SE approach emphasizes the formative influence of life experiences on the development of personality and on the genesis of problems, including habitual cannabis use. Cannabis users' most frequently reported psychological problems concerned feelings of insecurity, low self-image, extreme introversion, depression, and relationship problems. This chapter illustrates some of the SE psychotherapy processes, and how they lead to positive change. As interpersonal, social, intimacy, and work difficulties are often reported by cannabis users, SE dynamic psychotherapy approach may be particularly salient as it focuses not only on drug use, but also on the relationship between use and interpersonal problems. To date, evidence in the psychotherapy field suggests that longer treatment leads to better outcomes.
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