People with personality disorders and developmental conditions on an inpatient ward

Abstract

This chapter reviews research and expert guidelines on inpatient management of personality disorder, autism spectrum disorder, and adult attention deficit hyperactivity disorder. It covers use of medication, milieu approaches, other psychosocial interventions, the impact of the ward environment, quality assurance mechanisms, and the impact of institutionalization. Ways in which formal therapeutic approaches can be implemented on inpatient wards are also addressed. The effect of risky and challenging behaviours on defensive practice and staff burnout is covered, and detailed advice on managing suicidal and high-risk patients who are difficult to discharge safely is included. The chapter details specific approaches to milieu management, use of observations, personalized care plans, and communication styles in borderline personality disorder, autism spectrum disorder, and attention deficit hyperactivity disorder. Patients with these diagnoses constitute an important group of inpatients, and with careful management, iatrogenic harms can be avoided.