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      Ethnic variation in personality disorder: evaluation of 6 years of hospital admissions

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          Abstract

          Aims and method

          There is limited evidence on ethnic differences in personality disorder prevalence rates. We compared rates of people with personality disorder admitted to hospital in East London from 2007 to 2013.

          Results

          Of all people admitted to hospital, 9.7% had a personality disorder diagnosis. The admission rate for personality disorder has increased each year. Compared with White subjects, personality disorder was significantly less prevalent among Black and other minority ethnic (BME) groups. Personality disorder was diagnosed in 20% of forensic, 11% of general adult, 8% of adolescent and 2% of old-age in-patients.

          Clinical implications

          The increasing number of personality disorder diagnoses year on year indicates the increasing impact of personality disorder on in-patient services. It is important to identify and appropriately manage patients with a personality disorder diagnosis due to the significant strain they place on resources. The reasons for fewer admissions of BME patients may reflect alternative service use, a truly lower prevalence rate or under-detection.

          Declaration of interest

          None.

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          Most cited references25

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          Treatment utilization by patients with personality disorders.

          Utilization of mental health treatment was compared in patients with personality disorders and patients with major depressive disorder without personality disorder. Semistructured interviews were used to assess diagnosis and treatment history of 664 patients in four representative personality disorder groups-schizotypal, borderline, avoidant, and obsessive-compulsive-and in a comparison group of patients with major depressive disorder. Patients with personality disorders had more extensive histories of psychiatric outpatient, inpatient, and psychopharmacologic treatment than patients with major depressive disorder. Compared to the depression group, patients with borderline personality disorder were significantly more likely to have received every type of psychosocial treatment except self-help groups, and patients with obsessive-compulsive personality disorder reported greater utilization of individual psychotherapy. Patients with borderline personality disorder were also more likely to have used antianxiety, antidepressant, and mood stabilizer medications, and those with borderline or schizotypal personality disorder had a greater likelihood of having received antipsychotic medications. Patients with borderline personality disorder had received greater amounts of treatment, except for family/couples therapy and self-help, than the depressed patients and patients with other personality disorders. These results underscore the importance of considering personality disorders in diagnosis and treatment of psychiatric patients. Borderline and schizotypal personality disorder are associated with extensive use of mental health resources, and other, less severe personality disorders may not be addressed sufficiently in treatment planning. More work is needed to determine whether patients with personality disorders are receiving adequate and appropriate mental health treatments.
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            Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review.

            Inequalities of service use across ethnic groups are important to policy makers, service providers and service users. To identify ethnic variations in pathways to specialist mental health care, continuity of contact, voluntary and compulsory psychiatric in-patient admissions; to assess the methodological strength of the findings. A systematic review of all quantitative studies comparing use of mental health services by more than one ethnic group in the UK. Narrative analysis supplemented by meta-analysis, where appropriate. Most studies compared Black and White patients, finding higher rates of in-patient admission among Black patients. The pooled odds ratio for compulsory admission, Black patients compared with White patients, was 4.31 (95% CI 3.33-5.58). Black patients had more complex pathways to specialist care, with some evidence of ethnic variations in primary care assessments. There is strong evidence of variation between ethnic groups for voluntary and compulsory admissions, and some evidence of variation in pathways to specialist care.
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              DSM-IV personality disorders in the WHO World Mental Health Surveys.

              Little is known about the cross-national population prevalence or correlates of personality disorders. To estimate prevalence and correlates of DSM-IV personality disorder clusters in the World Health Organization World Mental Health (WMH) Surveys. International Personality Disorder Examination (IPDE) screening questions in 13 countries (n = 21 162) were calibrated to masked IPDE clinical diagnoses. Prevalence and correlates were estimated using multiple imputation. Prevalence estimates are 6.1% (s.e. = 0.3) for any personality disorder and 3.6% (s.e. = 0.3), 1.5% (s.e. = 0.1) and 2.7% (s.e. = 0.2) for Clusters A, B and C respectively. Personality disorders are significantly elevated among males, the previously married (Cluster C), unemployed (Cluster C), the young (Clusters A and B) and the poorly educated. Personality disorders are highly comorbid with Axis I disorders. Impairments associated with personality disorders are only partially explained by comorbidity. Personality disorders are relatively common disorders that often co-occur with Axis I disorders and are associated with significant role impairments beyond those due to comorbidity.
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                Author and article information

                Journal
                BJPsych Bull
                BJPsych Bull
                BJB
                BJPsych Bulletin
                Cambridge University Press (Cambridge, UK )
                2056-4694
                2056-4708
                August 2018
                : 42
                : 4
                : 157-161
                Affiliations
                [1 ]North East London National Health Service Foundation Trust
                [2 ]East London National Health Service Foundation Trust
                [3 ]Deancross Personality Disorder Service, East London National Health Service Foundation Trust
                [4 ]Queen Mary University of London
                Author notes
                Correspondence to Tennyson Lee ( tennyson.lee1@ 123456nhs.net )
                Article
                S2056469418000311 00031
                10.1192/bjb.2018.31
                6436062
                29897035
                6fb24801-13ec-4c56-8987-cc0c7ef363ba
                © The Authors 2018

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

                History
                : 05 February 2018
                : 05 April 2018
                : 06 April 2018
                Page count
                Figures: 1, Tables: 3, References: 34, Pages: 5
                Categories
                Original Papers

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