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Original papers: Maja Ranger, Caroline Methuen, Deborah Rutter, Bharti Rao, and Peter Tyrer Prevalence of personality disorder in the case-load of an inner-city assertive outreach team Psychiatr Bull 2004; 28: 441-443 [Abstract] [Full text] [PDF]

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prevalence of personality disorder in assertive outreach team

Vineet Singh, Preston PR29HT   (29 December 2004)

prevalence of personality disorder in assertive outreach team 29 December 2004
Vineet Singh, Specialist Registrar (Adult Psychiatry) Avondale Unit, Royal Preston Hospital, Preston PR29HT Send letter to journal: Re: prevalence of personality disorder in assertive outreach team vineet.singh{at}lancashirecare.nhs.uk Vineet Singh, et al.	It was interesting to read the study by Ranger et al December 2004, regarding prevalence of personality disorders in assertive outreach team. This highlights the need for more skills and resources in dealing with this complex client group. It also highlights the need for more psychotherapeutic models of management. The evidence base for psychotherapy has expanded (Roth & Fonagy, 1996). The cognitive analytical model of management (Ryle 1997) has been described with good success in borderline patients. Resentment over compulsory treatment, substance abuse,lack of insight and nonadherance with medication all commonly present as a barrier to a positive therapeutic relationship. The collaborative nature of reformulation process in CAT does offer scope in developing a joint sense of purpose with patient (Ryle 1990). However there are very limited avenues for clinicians to accquire these skills (Bateman, 2001). Therefore there is a need for more training and resources towards enhancing use of these approaches. There is evidence that patients with comorbid mental state and personality disorder actually have better outcome under a hospital oriented programme of care (Tyrer et al 1994),therefore the role of day hospitals should be carefully considered (Max Marshall BMJ, 2003). The inability of clinicians to deal with personality problems causes splitting,low morale and a sense of therepeutic paralysis which significantly impairs the overall functioning of the team. Dr Vineet Singh Referances: Ryle A (1990) CAT -Active participation in change-Chichester, John Wiley. Rees H (2000) CAT -a more suitable training for psychiatrists. Psychiatric Bulletin 24 124-126 Bateman A & Tyrer P (2004) Services for personality disorder, APT. Bateman A (2002) Psychotherapy training for Psychiatrists-hope,reality and resistance, Psychiatric Bulletin.