• Assessment of personality disorder

      Banerjee, Penny J. M.; Gibbon, Simon D.; Huband, Nick (2012)
    • Assessment of personality disorder

      Banerjee, Penny J. M.; Gibbon, Simon D.; Huband, Nick (2009)
      In 2003 the Department of Health, in conjunction with the National Institute for Mental Health in England, outlined the government's plan for the provision of mental health services for people with a diagnosis of personality disorder. This emphasised the need for practitioners to have skills in identifying, assessing and treating these disorders. It is important that personality disorders are properly assessed as they are common conditions that have a significant impact on an individual's functioning in all areas of life. Individuals with personality disorder are more vulnerable to other psychiatric disorders, and personality disorders can complicate recovery from severe mental illness. This article reviews the classification of personality disorder and some common assessment instruments. It also offers a structure for the assessment of personality disorder.
    • Autistic spectrum disorder, personality disorder and reading disability: A complex case that falls between the cracks?

      Baliousis, Michael; Vollm, Birgit A.; Banerjee, Penny J. M.; Duggan, Conor (2013)
      This case report describes an individual convicted of a violent offence whose complex mental health difficulties appear to be a reason for excluding him from services. During the individual's admission to a specialised service for personality disorder, a range of structured and semi-structured assessments identified an array of psychological difficulties. Clinical formulation was informed by a contemporary evidence-based typology and suggested that his violence was characterised by anxiety and vengeful/ruminative anger. The fact that the individual's needs were multiple including autism, personality disorder, dyslexia and a rare neuropsychological profile paradoxically appeared to be a reason for mental health services not to intervene, so that he continues to languish in prison. As forensic services in the future are likely to be required to provide for an increasingly difficult clientele, this case highlights not only potential deficiencies in current forensic mental health provision, but the challenges that services are likely to face in the future.
    • Brief psychoeducation for people with personality disorder: A pilot study

      Banerjee, Penny J. M.; Duggan, Conor; Huband, Nick; Watson, Neil (2006)
      Background. The Patients' Charter for Mental Health Services (DON, 1997) states that a patient is entitled to both know and understand his or her diagnosis. Despite this, personality disordered clients are not always well informed about their disorder. Some will not be told their diagnosis because of concern that to do so would damage the therapeutic alliance. Objective. To test the hypothesis that the therapeutic alliance is not compromised by engaging in a psychoeducation programme that informs about personality disorder. Design. Pilot study, pre-post design. Methods. Eighteen forensic in-patients and 16 community out-patients separately participated in a 4-session individual programme that focused on personality, personality disorder, and their own diagnosis. Understanding of these concepts was explored in a brief structured interview. Therapeutic alliance was assessed pre- and post-intervention using the Agnew relationship measure. Results. For both samples, participation in the intervention resulted in a positive change in four of the five measured components of the therapeutic alliance. This change was rated more strongly by clients than therapists, and reached statistical significance for bond, partnership, and confidence subscales. Participants demonstrated improved knowledge of their disorder following the intervention, and all but one gave positive feedback. Conclusion. These findings support the hypothesis and suggest the therapeutic relationship is not impaired when a diagnosis of personality disorder is imparted using this psychoeducation programme.
    • Personality disorder and psychopathy as predictors of psychosocial and criminological outcome in mentally disordered offenders

      McCarthy, Lucy; Huband, Nick; Patel, Shireen; Banerjee, Penny J. M.; Duggan, Conor (2012)
      Ninety-five patients discharged from a specialist Personality Disorder (PD) service were prospectively assessed for Axis II disorders and Psychopathy. Sequential regression models tested the ability of different conceptual definitions of PD and Psychopathy to predict criminological and psychosocial outcome over a mean follow-up of 4.16 years. Trait definitions of PD modestly predicted criminological outcome. After controlling for age, IQ and PD, time to first reconviction after entering the community was predicted by PCL-R Factors 1, 2, and previous convictions. Psychosocial outcome was predicted by PCL-R with high scores on the affective-interpersonal Factor 1 providing strongest prediction of poor psychosocial outcome.
    • Value of standard personality assessments in informing clinical decision-making in a medium secure unit

      Duggan, Conor; Mason, Lauren; Banerjee, Penny J. M.; Milton, John (2007)
      Background: Assessing those with personality disorder for treatment in secure settings is known to be unsatisfactory. Aim: To examine the utility of a standardised assessment of offenders with personality disorder referred for treatment in secure care in a naturalistic study. Method: A consecutive series of 89 men were assessed with a battery of four recommended instruments measuring personality and risk. Decisions on whether or not to admit were based on a multidisciplinary discussion informed by these assessments. Results: Of the 89 comprehensively assessed referrals, 60 (67%) were offered admission. High scores on the Psychopathy Checklist-Revised (especially on Factor I) was the only measure that was associated with rejection. Of 44 patients discharged, 29 (66%) failed to complete treatment; none of the pre-admission assessments distinguished 'completers' from 'non-completers'. Although skills were acquired on the unit, follow-up of 24 men in the community showed that this had only a marginal effect on re-offending rate (58%). Conclusions: Current recommended assessment methods appear unsatisfactory in identifying those who either (a) complete treatment or (b) benefit from treatment. Our results throw doubt on their value.