Alison is 35 years old and has a diagnosis of Borderline Personality Disorder.
Alison has been brought to A&E for the 3rd time in 2 weeks, this time following a serious overdose of 18x 500mg paracetamol and 14x 20mg citalopram. She had been found unconscious by her partner who called an ambulance. Her partner had unexpectedly finished work early so was home 2 hours earlier than usual.
The two previous visits were following an overdose of paracetamol of 12x 500mg tablets and then a self-inflicted laceration to her left wrist which required 3 stitches. Following the overdose Alison had collapsed in the street and a member of the public had called an ambulance. Following the laceration Alison called ambulance herself. On both of these occasions she left before the Duty Psychiatrist or Psychiatric Liaison Nurse saw her.
Alison was diagnosed with a Borderline Personality Disorder 12 years earlier. She has had repeated short admissions to acute psychiatric services across the south of England, which resulted in her transfer back to local services. She has numerous scars on her forearms and thighs from self-inflicted injuries. After the last admission 4 ½ years ago she was engaged in therapy and had regularly outpatient appointments.
Personal and social history:
Alison left school at 16 with no GCSEs. She worked in a local hairdressers till she was 22years old when the hairdressers closed down, she has not worked since. Alison was sexually abused by her step-father from the ages of 5 to 14years. He was subsequently charged and imprisoned.
She met her current partner 3 years ago and they have lived together for the last 18months. Prior to this relationship Alison had had no significant relationship in her opinion.
20mg citalopram OD
5mg diazepam TDS
Seen by A&E Psychiatric Liaison Nurse with Duty Psychiatrist before she was medically cleared. She has a fresh dressing on her left wrist and has been prescribed a course of antibiotics because the wound has become infected.
On assessment Alison is very distressed, she can’t believe she is alive. Alison is very angry with her partner for saving her life.
Alison knew exactly what medication she had taken and explained she had not taken any diazepam because she had no tablets left, but would have done if she had any.
Objectively & subjectively low in mood. Reports disturbed sleep for the last 3 weeks and using alcohol to sleep. She admits to sporadically taking her antidepressant, believing it’s not helping, and has been taking more than the prescribed dose of diazepam.
Alison disclosed that her psychodynamic counselling sessions finished 1 month ago.
The partner shared they had recently found out from Alison’s mother that the step father is due to be released on parole.
A referral is made immediately to the Home Treatment Team to discuss admission.