Mental health service use and costs associated with complex emotional needs and a diagnosis of personality disorder: analysis of routine data

AIMS AND METHOD

We aimed to estimate the costs of care for people with a personality disorder diagnosis and compare service use and costs for those receiving specialist input and those receiving generic care. Service use data were obtained from records and costs calculated. Comparisons were made between those who received care from specialist personality disorder teams and those who did not. Demographic and clinical predictors of costs were identified with regression modelling.

RESULTS

Mean total costs before diagnosis were £10 156 for the specialist group and £11 531 for the non-specialist group. Post-diagnosis costs were £24 017 and £22 266 respectively. Costs were associated with specialist care, comorbid conditions and living outside of London.

CLINICAL IMPLICATIONS

Receiving increased support from a specialist service may reduce the need for in-patient care. This may be clinically appropriate and results in a distribution of costs.

Antigen transport. I. Demonstration and characterization of cells laden with antigen in thoracic duct lymph and blood

Thoracic duct lymph (TDL) of nonimmune rats and mice was examined for the presence of antigen-carrying cells immediately following a single injection of 125I-labelled or fluorescence-labelled serum protein antigens. Small numbers of cells laden with antigen (approximately 1/2000 to 1/5000) were identified in TDL and blood by autoradiography or fluorescence microscopy. The antigen-laden (Ag-L) cells resembled macrophages in that a large number adhered to plastic, they phagocytosed bacteria or a particulate dye, were non-specific esterase positive, radioresistant and could take up more than one antigen at one time in vivo. Surface phenotyping using monoclonal antibodies against rat cell markers established that Ag-L cells did not express Ia determinants. The results suggest the existence of a subpopulation of macrophage-related cells that may be involved in the transport of antigen and in stimulation of antibody responses.