Extreme Challenges - Psychopathology & Treatment Experiences Among Severly Selfharming Inpatients in Norway
English Title: Extreme Challenges - Psychopathology, Treatment Organization and Experiences Among Psychiatric Inpatients With Severe Self-harming Behavior in Norway
2 other identifiers
observational
1,640
1 country
1
Brief Summary
Patients who self-harm are a heterogeneous population. Outpatient treatments structured for borderline personality disorder are often recommended and hospitalization kept to a minimum. However, few studies have focused on the most severe, complex conditions with extreme suicide risk. A recent national investigation from Norway (2017) demonstrated a far larger cohort of extensively hospitalized inpatients with extreme self-harming behaviors than was expected (N=427) - identified in all health regions. Reported challenges were high-risk situations, severe medical sequelae, difficult collaborations across services, and uncertainty about psychiatric diagnoses. Severe, often bizarre, self-harm is thus a major challenge for both patients and health services. In hospitals, safety measures can involve restrictions and involuntary regimes. As research on this target population is sparse, the current project seeks further understanding of complex conditions - psychopathology, treatment experiences and service collaboration. The project is a national, multi-center cooperation including patients in psychiatric hospitals in all health regions. It is cross sectional. Data is based on diagnostic interviews, patients' self-reported symptoms and both patients and service providers treatment experiences. The inclusion period for inpatients (N=300) and a comparison sample of outpatients (N=300) is one year. The target group is inpatients with extreme hospitalization and severe self-mutilation. A comparison group is patients with personality pathology attending outpatient treatments. Recruitment is across health regions. Aim 1: Investigate psychopathology of patients in the target population and compare to a clinical sample admitted to outpatient treatment Aim 2: Investigate personality functioning in the target population and compare to a clinical sample admitted to outpatient treatment Aim 3: a) Investigate health service use in the target population and compare to a clinical sample admitted to outpatient treatment. b) Investigate treatment experiences and health service collaborations in the target population. The project will provide rational for future preventive treatment interventions
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for all trials
Started Oct 2019
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
November 11, 2018
CompletedFirst Posted
Study publicly available on registry
December 7, 2018
CompletedStudy Start
First participant enrolled
October 1, 2019
CompletedPrimary Completion
Last participant's last visit for primary outcome
September 1, 2021
CompletedStudy Completion
Last participant's last visit for all outcomes
September 1, 2021
CompletedJune 21, 2024
June 1, 2024
1.9 years
November 11, 2018
June 20, 2024
Conditions
Keywords
Outcome Measures
Primary Outcomes (21)
Psychiatric Disorders as assessed by M.I.N.I.plus
Diagnoses will be assessed by use of semistructured clinical interview: Mini International Neuropsychiatric Interview (M.I.N.I plus)
2019-2021
Post Traumatic Stress Disorder as assessed by PTSD CL 5
Presence and severity of PTSD symptoms will be assessed by PTSD Checklist for DSM-5 (PTSD CL 5)
2019-2021
Severity of psychiatric symptoms as assessed by PHQ
Severity of symptoms will be assessed by patient-reports based on the Patient Health Questionairre (PHQ)
2019-2021
Screening for substance use disorder as assessed by AUDIT/DUDIT
Additional screening for substance abuse by self-report Alcohol/Drug use disorder identification test (AUDIT/DUDIT)
2019-2021
Personality Disorders as assessed by SCID 5 PD
Diagnoses will be assessed by use of the Structured Clinical interview for Diagnoses of Personality Disorders according to DSM-5: SCID-5-PD
2019-2021
Psychosocial functioning I as assessed by GAF
Global functioning will be assessed by use of the observer-rated Global assessment of functioning (GAF)
2019-2021
Psychosocial functioning II as assessed by WSAS
Global functioning will be assessed by use of self-report: WOrk and Social adjustment Scale (WSAS)
2019-2021
Learning disability screening as assessed by HASI
Learning disability will be assessed by use of Hayes Ability Screening Index (HASI)
2019-2021
Autism spectrum screening as assessed by RAADS-R
Screening for autism will entail use of The Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R)
2019-2021
Overall personality functioning as assessed by SIPP-118
Assessment of personality functioning entails use of the Severity Indices for Personality Functioning (SIPP-118)
2019-2021
Emotional regulation as assessed by DERS
Assessment of problems with emotional dysregulation entails use of Difficulties in emotional regulation scale (DERS)
2019-2021
Aggressive behaviors as assessed by MOAS
Assessment of problems with aggressive outbursts or behaviors will be assessed by Items from the Modified Overt Aggression Scale (MOAS)
2019-2021
Alexithymia as assessed by TAS-20
Assessment of aspects of affect consciousness will be assessed by the Toronto Alexithymia scale (TAS-20)
2019-2021
Close relationships and attachment patterns as assessed by ECR
Assessment of capacities and maladaptive patterns in close relationships will be assessed by the inventory: Experiences in close relationships (ECR).
2019-2021
Selfharming behaviors as assessed by LPC
Detailed assessment of selfharming behaviors will entail use of the interview: Lifetime Para suicide Count (LPC)
2019-2021
Specialist mental health service utilization I as assessed by specific interview
Interview designed for this project for systematic assessment of the volume of service use last six months (number of outpatient consultations).
2019-2021
Specialist mental health service utilization II as assessed by specific interview
Interview designed for this project for systematic assessment of the volume of service use last six months (number of inpatient (hospital) admissions).
2019-2021
Specialist mental health service utilization III as assessed by specific interview
Interview designed for this project for systematic assessment of the volume of service use last six months (number of inpatient days in hospital).
2019-2021
Specialist mental health service treatment as assessed by specific interview
Interview designed for this project for systematic assessment of type of treatment (category) received last six months.
2019-2021
Welfare services as assessed by specific interview
Interview designed for this project for systematic assessment of type of welfare service (category) last six months.
2019-2021
Age at first contact with specialist mental health services as assessed by specific interview
Age (years) at first contact with mental health services
2019-2021
Study Arms (2)
Inpatient cohort (Target group)
Inpatient at mental health centre/ psychiatric hospital due to severe self-harm. Duration \> 4 weeks and/or \> five admissions last year. Assessment of diagnoses, functioning and health services
Outpatient comparison cohort
Admitted to treatment within Norwegian Network of personality-focused treatment during 2017-2018. Assessment of diagnoses, functioning and health services
Interventions
Systematic differential diagnostics, assessment of psychosocial and personality functioning and treatment/ health services
Eligibility Criteria
The target population is patients with extensive hospitalization due to selfharming behaviors
You may qualify if:
- Admitted to inpatient units (adult psychiatry, mental health centres or hospitals) due to risk of severe self-harm.
- Duration of admissions either \> 4 weeks and/or \> five admissions preceding year.
You may not qualify if:
- Not inpatients at a psychiatric, adult (18-60 yrs) institution
- Assessed for outpatient treatment within the outpatient Network
- Assessed but not admitted to outpatient treatment within the Network
Contact the study team to confirm eligibility.
Sponsors & Collaborators
- Oslo University Hospitallead
- Extrastiftelsencollaborator
- National Advisory Unit for Personality Psychiatry (NAPP)collaborator
- Research Group Personality Psychiatrycollaborator
- Network for personality-focused treatmentcollaborator
- National Centre for Suicide Research and Prevention (NSSF)collaborator
- Regional Centre for Violence and Traumatic Stress (RVTS)collaborator
- Regional Centre for Early Intervention Psychosis (TIPS SØrØst)collaborator
- Regional collaborators and userscollaborator
Study Sites (1)
Oslo University Hospital
Oslo, 0424, Norway
MeSH Terms
Conditions
Interventions
Condition Hierarchy (Ancestors)
Intervention Hierarchy (Ancestors)
Study Officials
- PRINCIPAL INVESTIGATOR
Elfrida H Kvarstein, MD,PhD
Oslo University Hospital
Study Design
- Study Type
- observational
- Observational Model
- COHORT
- Time Perspective
- CROSS SECTIONAL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Head senior consultant/Associate Professor
Study Record Dates
First Submitted
November 11, 2018
First Posted
December 7, 2018
Study Start
October 1, 2019
Primary Completion
September 1, 2021
Study Completion
September 1, 2021
Last Updated
June 21, 2024
Record last verified: 2024-06
Data Sharing
- IPD Sharing
- Will not share