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Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desouza A, Nayak O, Praharaj SK, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Ghosh P, Lakdawala B, Bhattacharya R. Factors associated with lifetime suicide attempts: findings from the bipolar disorder course and outcome study from India (BiD-CoIN study). Nord J Psychiatry 2022; 77:227-233. [PMID: 35732027 DOI: 10.1080/08039488.2022.2083231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM To evaluate the risk factors associated with lifetime suicide attempts in bipolar disorder (BD) patients. METHODOLOGY 773 BD patients with a duration of illness of at least ten years, currently in clinical remission, were evaluated for suicidal attempts in their lifetime. Those with and without lifetime suicide attempt(s) were compared for various demographic and clinical risk factors. RESULTS 242 (31.3%) patients had a history of at least one lifetime suicide attempt. Compared to those without lifetime suicide attempts, those with suicidal attempts were less educated, were more often females, spent more time in episodes, and had a significantly more number of total episodes (in the lifetime, first five years of illness, and per year of illness), had significantly more number of total depressive episodes (in the lifetime, first five years of illness, and per year of illness), spent more time in depressive episodes, had more severe depressive episodes, more often had depression as the first episode in the lifetime, spent more time in mania/hypomania/mixed episodes, had higher residual depressive and manic symptoms, more often had rapid cycling affective disorder pattern in the lifetime, use of cannabis in dependence pattern, had poorer insight into their illness and had a higher level of disability (especially in three out of the four domains of Indian disability evaluation assessment scale). CONCLUSIONS About one-third of the patients with BD have at least one-lifetime suicidal attempt, and those with suicide attempts usually have a poorer course of illness.
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Affiliation(s)
- Sandeep Grover
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Ajit Avasthi
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rahul Chakravarty
- Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Amitava Dan
- Burdwan Medical College & Hospital, Burdwan, India
| | | | | | - Avinash Desouza
- Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai, India
| | - Omkar Nayak
- Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai, India
| | - Samir Kumar Praharaj
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Vikas Menon
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raman Deep
- All India Institute of Medical Sciences, New Delhi, India
| | - Manish Bathla
- Maharishi Markandeshwar Institute of Medical Sciences & Research, Mullana, India
| | | | | | | | - Bhavesh Lakdawala
- Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, India
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Abstract
Patients with bipolar disorders experience cyclical changes in mood that present as a range of different syndromes. In classical mania, patients experience episodes of euphoria, whereas in depressive episodes they suffer from depression. In hypomania, patients experience a milder form of mania, and in mixed mania, patients may experience both manic and depressive symptoms simultaneously, or alternate between them rapidly. Because of this wide range of symptoms, bipolar disorders can appear to overlap with other mental disorders, especially personality disorders.
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Azorin J, Kaladjian A, Adida M, Fakra E, Belzeaux R, Hantouche E, Lancrenon S. Factors associated with borderline personality disorder in major depressive patients and their relationship to bipolarity. Eur Psychiatry 2020; 28:463-8. [DOI: 10.1016/j.eurpsy.2012.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/12/2012] [Accepted: 11/23/2012] [Indexed: 12/31/2022] Open
Abstract
AbstractObjectiveTo analyze the interface between borderline personality disorder (BPD) and bipolarity in depressed patients comorbid with BPD.MethodsAs part of National Multi-site Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 19 (3.9%) had comorbid BPD (BPD+), whereas 474 (96.1%) did not manifest this comorbidity (BPD−).ResultsCompared to BPD (−), BPD (+) patients displayed higher rates of bipolar (BP) disorders and temperaments, an earlier age at onset with a family history of affective illness, more comorbidity, more stressors before the first episode which was more often depressive or mixed, as well as a greater number and severity of affective episodes.ConclusionsThe hypothesis which fitted at best our findings was to consider BPD as a contributory factor in the development of BP disorder, which could have favoured the progression from unipolar major depression to BP disorder. We could not however exclude that some features of BP disorder may have contributed to the development of BPD.
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Bayes A, Parker G, Paris J. Differential Diagnosis of Bipolar II Disorder and Borderline Personality Disorder. Curr Psychiatry Rep 2019; 21:125. [PMID: 31749106 DOI: 10.1007/s11920-019-1120-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE OF REVIEW Differentiating bipolar (BP) disorders (in particular BP II) from borderline personality disorder (BPD) is a common diagnostic dilemma. We sought to critically examine recent studies that considered clinical differences between BP II and BPD, which might advance their delineation. RECENT FINDINGS Recent studies focused on differentiating biological parameters-genetics, epigenetics, diurnal rhythms, structural and functional neuroimaging-with indicative differences not yet sufficient to guide diagnosis. Key differentiating factors include family history, developmental antecedents, illness course, phenomenological differences in mood states, personality style and relationship factors. Less differentiating factors include impulsivity, neuropsychological profiles, gender distribution, comorbidity and treatment response. This review details parameters offering differentiation of BP II from BPD and should assist in resolving a frequent diagnostic dilemma. Future studies should specifically examine the BP II subtype directly with BPD, which would aid in sharpening the distinction between the disorders.
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Affiliation(s)
- Adam Bayes
- School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia. .,Black Dog Institute, Sydney, NSW, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales (UNSW), Sydney, Australia.,Black Dog Institute, Sydney, NSW, Australia
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Plans L, Barrot C, Nieto E, Rios J, Schulze TG, Papiol S, Mitjans M, Vieta E, Benabarre A. Association between completed suicide and bipolar disorder: A systematic review of the literature. J Affect Disord 2019; 242:111-122. [PMID: 30173059 DOI: 10.1016/j.jad.2018.08.054] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/25/2018] [Accepted: 08/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Completed suicide is a major cause of death in bipolar disorder (BD) patients. OBJECTIVE The aim of this paper is to provide an overall review of the existing literature of completed suicide in BD patients, including clinical and genetic data DATA SOURCES: We performed a systematic review of English and non-English articles published on MEDLINE/PubMed, PsycInfo and Cochrane database (1970-2017). Additional studies were identified by contacting clinical experts, searching bibliographies, major textbooks and website of World Health Organization. Initially we did a broad search for the association of bipolar disorder and suicide and we were narrowing the search in terms included "bipolar disorder" and "completed suicide". STUDY SELECTION Inclusion criteria were articles about completed suicide in patients with BD. Articles exclusively focusing on suicide attempts and suicidal behaviour have been excluded. We used PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) consensus for drafting this systematic review. RESULTS The initial search generated 2806 articles and a total of 61 meeting our inclusion criteria. We reviewed epidemiological data, genetic factors, risk factors and treatment of completed suicide in BD. Suicide rates in BD vary between studies but our analyses show that they are approximately 20-30-fold greater than in general population. The highest risk of successful suicide was observed in BD-II subjects. The heritability of completed suicide is about 40% and some genes related to major neurotransmitter systems have been associated with suicide. Lithium is the only treatment that has shown anti-suicide potential. LIMITATIONS The most important limitation of the present review is the limited existing literature on completed suicide in BD. CONCLUSIONS BD patients are at high risk for suicide. It is possible to identify some factors related to completed suicide, such as early onset, family history of suicide among first-degree relatives, previous attempted suicides, comorbidities and treatment. However it is necessary to promote research on this serious health problem.
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Affiliation(s)
- L Plans
- Mental Health Division of Althaia, Xarxa Assistencial Universitària de Manresa, Catalonia, Spain
| | - C Barrot
- Forensic Genetic Laboratori, University of Barcelona, Catalonia, Spain
| | - E Nieto
- Mental Health Division of Althaia, Xarxa Assistencial Universitària de Manresa, Catalonia, Spain
| | - J Rios
- Universitat Autònoma de Barcelona, Laboratório de Bioestatística e Epidemiologia, Barcelona, Spain; Hospital Clínic, IDIBAPS, Bioestadística y Plataforma de Gestión de Datos, Barcelona, Spain
| | - T G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig Maximilian University, Munich, Germany
| | - S Papiol
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig Maximilian University, Munich, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - M Mitjans
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - E Vieta
- Bipolar Disorder Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
| | - A Benabarre
- Bipolar Disorder Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Abstract
Recent work suggests that a broad clinical spectrum of bipolar disorder is more common than previously thought and that the disorder may affect up to 5% of the population. The correct definition and diagnosis of hypomania is central to the identification of bipolar disorder. In this review we focus on recent diagnostic and clinical advances relating to bipolar disorder, with particular reference to hypomanic states. We also highlight some of the controversies in this field and discuss ways in which clinicians might improve their detection of bipolar disorders.
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Riemann G, Weisscher N, Post RM, Altshuler L, McElroy S, Frye MA, Keck PE, Leverich GS, Suppes T, Grunze H, Nolen WA, Kupka RW. The relationship between self-reported borderline personality features and prospective illness course in bipolar disorder. Int J Bipolar Disord 2017; 5:31. [PMID: 28944443 PMCID: PMC5610955 DOI: 10.1186/s40345-017-0100-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/04/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although bipolar disorder (BD) and borderline personality disorder (BPD) share clinical characteristics and frequently co-occur, their interrelationship is controversial. Especially, the differentiation of rapid cycling BD and BPD can be troublesome. This study investigates the relationship between borderline personality features (BPF) and prospective illness course in patients with BD, and explores the effects of current mood state on self-reported BPF profiles. METHODS The study included 375 patients who participated in the former Stanley Foundation Bipolar Network. All patients met DSM-IV criteria for bipolar-I disorder (n = 294), bipolar-II disorder (n = 72) or bipolar disorder NOS (n = 9). BPF were assessed with the self-rated Personality Diagnostic Questionnaire. Illness course was based on 1-year clinician rated prospective daily mood ratings with the life chart methodology. Regression analyses were used to estimate the relationships among these variables. RESULTS Although correlations were weak, results showed that having more BPF at baseline is associated with a higher episode frequency during subsequent 1-year follow-up. Of the nine BPF, affective instability, impulsivity, and self-mutilation/suicidality showed a relationship to full-duration as well as brief episode frequency. In contrast all other BPF were not related to episode frequency. CONCLUSIONS Having more BPF was associated with an unfavorable illness course of BD. Affective instability, impulsivity, and self-mutilation/suicidality are associated with both rapid cycling BD and BPD. Still, many core features of BPD show no relationship to rapid cycling BD and can help in the differential diagnosis.
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Affiliation(s)
- Georg Riemann
- Saxion, University of Applied Science, Handelskade 75, 7417 DH Deventer, The Netherlands
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, The Netherlands
| | - Nadine Weisscher
- GGZ Centraal, Center for Mental Health, Hilversum, The Netherlands
| | - Robert M. Post
- Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814 USA
- 0000 0004 1936 9510grid.253615.6Psychiatry and Behavioral Sciences, George Washington University, Washington, DC USA
| | - Lori Altshuler
- grid.416792.fFormer Head UCLA Mood Disorders Research Program, VA Medical Center, Los Angeles, CA USA
| | - Susan McElroy
- Lindner Center of HOPE, Mason, OH USA
- 0000 0001 2179 9593grid.24827.3bBiological Psychiatry Program, University of Cincinnati Medical College, Cincinnati, OH USA
| | - Marc A. Frye
- 0000 0004 0459 167Xgrid.66875.3aPsychiatry, Mayo Clinic, Rochester, MI USA
| | - Paul E. Keck
- Lindner Center of HOPE, Mason, OH USA
- 0000 0001 2179 9593grid.24827.3bPsychiatry & Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Gabriele S. Leverich
- Bipolar Collaborative Network, 5415 W. Cedar Ln, Suite 201-B, Bethesda, MD 20814 USA
| | - Trisha Suppes
- 0000000419368956grid.168010.eDepartment of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA USA
| | - Heinz Grunze
- 0000 0004 0523 5263grid.21604.31Paracelsus Medical University, Salzburg, Austria
| | - Willem A. Nolen
- 0000 0004 0407 1981grid.4830.fUniversity Medical Center, University of Groningen, Groningen, The Netherlands
| | - Ralph W. Kupka
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
- 0000 0004 0546 0540grid.420193.dGGZ inGeest, Center for Mental Health Care, Amsterdam, The Netherlands
- grid.413664.2Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
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Ng TH, Burke TA, Stange JP, Walshaw PD, Weiss RB, Urosevic S, Abramson LY, Alloy LB. Personality disorder symptom severity predicts onset of mood episodes and conversion to bipolar I disorder in individuals with bipolar spectrum disorder. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:271-284. [PMID: 28368159 PMCID: PMC5380154 DOI: 10.1037/abn0000255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although personality disorders (PDs) are highly comorbid with bipolar spectrum disorders (BSDs), little longitudinal research has been conducted to examine the prospective impact of PD symptoms on the course of BSDs. The aim of this study is to examine whether PD symptom severity predicts shorter time to onset of bipolar mood episodes and conversion to bipolar I disorder over time among individuals with less severe BSDs. Participants (n = 166) with bipolar II disorder, cyclothymia, or bipolar disorder not otherwise specified completed diagnostic interview assessments of PD symptoms and self-report measures of mood symptoms at baseline. They were followed prospectively with diagnostic interviews every 4 months for an average of 3.02 years. Cox proportional hazard regression analyses indicated that overall PD symptom severity significantly predicted shorter time to onset of hypomanic (hazard ratio [HR] = 1.42; p < .001) and major depressive episodes (HR = 1.51; p < .001) and conversion to bipolar I disorder (HR = 2.51; p < .001), after controlling for mood symptoms. Results also suggested that cluster B severity predicted shorter time to onset of hypomanic episodes (HR = 1.38; p = .002) and major depressive episodes (HR = 1.35; p = .01) and conversion to bipolar I disorder (HR = 2.77; p < .001), whereas cluster C severity (HR = 1.56; p < .001) predicted shorter time to onset of major depressive episodes. These results support predisposition models in suggesting that PD symptoms may act as a risk factor for a more severe course of BSDs. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Patricia D Walshaw
- Semel Institute for Neuroscience and Human Behavior, University of California
| | | | | | - Lyn Y Abramson
- Department of Psychology, University of Wisconsin-Madison
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Martino DJ, Marengo E, Igoa A, Scápola M, Urtueta-Baamonde M, Strejilevich SA. Accuracy of the number of previous episodes reported by patients with bipolar disorder. Compr Psychiatry 2016; 65:122-7. [PMID: 26774000 DOI: 10.1016/j.comppsych.2015.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 11/15/2015] [Accepted: 11/17/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The number of previous episodes in patients with BD is a variable widely used for both clinical and research purposes. The aim of this study was to compare the number of episodes retrospectively reported by euthymic BD subjects with that registered by their psychiatrists during a follow-up period. METHODS Fifty euthymic patients with BD and more than 2years of follow-up were retrospectively asked in a standardized fashion about the number of hypomanic/manic and depressive episodes suffered during that period. Patient-reported outcomes were compared with the number of episodes registered by psychiatrists in a life chart during the same period. RESULTS The mean follow-up of patients was 66.70months. There was a mean difference of 2.74 episodes between reports of patients' and psychiatrists' reports during the complete follow-up period; Intraclass correlation coefficient was 0.40 (CI95%=0.15-0.61). This difference increased with the duration of the follow-up period (R=0.33, p=0.023) and with the number of episodes occurred during that (R=0.32, p=0.023). The difference between patient-reported and clinician-rated in the number of depressive during the follow-up period was more pronounced in BDII than in BDI (Z=-2.47, p=0.014), and it correlated with the number of previous depressive episodes at baseline (R=0.28, p=0.047) and subclinical depressive symptoms (R=0.41, p=0.003). CONCLUSIONS The number of previous episodes referred by patients with BD is not an accurate measure of the true number of episodes suffered. The theoretical and practical implications of these findings are discussed.
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Affiliation(s)
- Diego J Martino
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Av. Belgrano 1746, (C1093AAS) Ciudad Autónoma de Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Av Rivadavia 1917 (C1033AAJ) Ciudad Autónoma de Buenos Aires, Argentina.
| | - Eliana Marengo
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Av. Belgrano 1746, (C1093AAS) Ciudad Autónoma de Buenos Aires, Argentina; National Council of Scientific and Technical Research (CONICET), Av Rivadavia 1917 (C1033AAJ) Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Igoa
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Av. Belgrano 1746, (C1093AAS) Ciudad Autónoma de Buenos Aires, Argentina
| | - María Scápola
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Av. Belgrano 1746, (C1093AAS) Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariana Urtueta-Baamonde
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Av. Belgrano 1746, (C1093AAS) Ciudad Autónoma de Buenos Aires, Argentina
| | - Sergio A Strejilevich
- Bipolar Disorder Program, Neuroscience Institute, Favaloro University, Av. Belgrano 1746, (C1093AAS) Ciudad Autónoma de Buenos Aires, Argentina; Institute of Cognitive Neurology (INECO), Pacheco de Melo 1860 (C1126AAB) Ciudad Autónoma de Buenos Aires, Argentina
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Yen S, Frazier E, Hower H, Weinstock LM, Topor DR, Hunt J, Goldstein TR, Goldstein BI, Gill MK, Ryan ND, Strober M, Birmaher B, Keller MB. Borderline personality disorder in transition age youth with bipolar disorder. Acta Psychiatr Scand 2015; 132:270-80. [PMID: 25865120 PMCID: PMC4573347 DOI: 10.1111/acps.12415] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine the longitudinal impact of borderline personality disorder (BPD) on the course and outcome of bipolar disorder (BP) in a pediatric BP sample. METHOD Participants (N = 271) and parents from the Course and Outcome of Bipolar Youth (COBY) study were administered structured clinical interviews and self-reports on average every 8.7 months over a mean of 93 months starting at age 13.0 ± 3.1 years. The structured interview for DSM-IV personality disorders (SIDP-IV) was administered at the first follow-up after age 18 to assess for symptoms of BPD. BPD operationalized at the disorder, factor, and symptom level, was examined as a predictor of poor clinical course of BP using all years of follow-up data. RESULTS The number of BPD symptoms was significantly associated with poor clinical course of BP, above and beyond BP characteristics. Affective dysregulation was most strongly associated with poor course at the factor level; the individual symptoms most strongly associated with poor course were dissociation/stress-related paranoid ideation, impulsivity, and affective instability. CONCLUSION BPD severity adds significantly to the burden of BP illness and is significantly associated with a more chronic and severe course and outcome beyond what can be attributable to BP characteristics.
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Affiliation(s)
- Shirley Yen
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Butler Hospital, Providence, Rhode Island, United States
| | - Elisabeth Frazier
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, United States
| | - Heather Hower
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Lauren M. Weinstock
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Butler Hospital, Providence, Rhode Island, United States
| | - David R. Topor
- VA Boston Healthcare System and Harvard Medical School, Cambridge, Massachusetts, United States
| | - Jeffrey Hunt
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University,Emma Pendleton Bradley Hospital, East Providence, Rhode Island, United States
| | - Tina R. Goldstein
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Benjamin I. Goldstein
- Department of Child Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto Medical Center, Toronto, Ontario, Canada
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Neal D. Ryan
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, CA, United States
| | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Fulford D, Eisner LR, Johnson SL. Differentiating risk for mania and borderline personality disorder: The nature of goal regulation and impulsivity. Psychiatry Res 2015; 227:347-52. [PMID: 25892256 DOI: 10.1016/j.psychres.2015.02.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 01/25/2015] [Accepted: 02/01/2015] [Indexed: 01/19/2023]
Abstract
Researchers and clinicians have long noted the overlap among features and high comorbidity of bipolar disorder and borderline personality disorder. The shared features of impulsivity and labile mood in both disorders make them challenging to distinguish. We tested the hypothesis that variables related to goal dysregulation would be uniquely related to risk for mania, while emotion-relevant impulsivity would be related to risk for both disorders. We administered a broad range of measures related to goal regulation traits and impulsivity to 214 undergraduates. Findings confirmed that risk for mania, but not for borderline personality disorder, was related to higher sensitivity to reward and intense pursuit of goals. In contrast, borderline personality disorder symptoms related more strongly than did mania risk with threat sensitivity and with impulsivity in the context of negative affect. Results highlight potential differences and commonalities in mania risk versus borderline personality disorder risk.
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Affiliation(s)
- Daniel Fulford
- University of California, San Francisco, Department of Psychiatry, 401 Parnassus Ave., San Francisco, CA 94143, USA; Palo Alto Medical Foundation Research Institute, 2350 West El Camino Real, Mountain View, CA 94040, USA.
| | - Lori R Eisner
- Bipolar Clinic and Research Program, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, 50 Staniford St., Ste 580, Boston, MA 02114, USA
| | - Sheri L Johnson
- University of California, Berkeley, Department of Psychology, 3417 Tolman Hall, Berkeley, CA 94720, USA
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Bezerra-Filho S, Almeida AGD, Studart P, Rocha MV, Lopes FL, Miranda-Scippa Â. Personality disorders in euthymic bipolar patients: a systematic review. REVISTA BRASILEIRA DE PSIQUIATRIA 2015; 37:162-7. [DOI: 10.1590/1516-4446-2014-1459] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/24/2014] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Paula Studart
- Universidade Federal da Bahia, Brazil; Universidade Federal da Bahia, Brazil
| | - Marlos V. Rocha
- Universidade Federal da Bahia, Brazil; Universidade Federal da Bahia, Brazil
| | - Frederico L. Lopes
- Universidade Federal da Bahia, Brazil; Universidade Federal da Bahia, Brazil
| | - Ângela Miranda-Scippa
- Universidade Federal da Bahia, Brazil; Universidade Federal da Bahia, Brazil; Universidade Federal da Bahia, Brazil
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Co-morbidity of bipolar disorder and borderline personality disorder: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Compr Psychiatry 2015; 58:18-28. [PMID: 25666748 DOI: 10.1016/j.comppsych.2015.01.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Clinical studies suggest a high co-morbidity rate of borderline personality disorder (BPD) with bipolar disorder (BD). This study examines the prevalence and correlates of BPD in BD (I and II) in a longitudinal population-based survey. METHODS Data came from waves 1 and 2 (wave 2: N=34,653, 70.2% cumulative response rate; age ≥ 20 years) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Lay interviewers conducted in person interviews using the Alcohol Use Disorders and Associated Disabilities Interview (AUDADIS-IV), a reliable diagnostic tool of psychiatric disorders based on DSM-IV criteria. Subjects with BD I (n=812), BD I/BPD (n=360), BD II (n=327) and BD II/BPD (n=101) were examined in terms of sociodemographics, mood, anxiety, substance use and personality disorder co-morbidities and history of childhood traumatic experiences. RESULTS Lifetime prevalence of BPD was 29.0% in BD I and 24.0% in BD II. Significant differences were observed between co-morbid BD I/II and BPD versus BD I/II without BPD in terms of number of depressive episodes and age of onset, co-morbidity, and childhood trauma. BPD was strongly and positively associated with incident BD I (AOR=16.9; 95% CI: 13.88-20.55) and BD II (AOR=9.5; 95% CI: 6.44-13.97). CONCLUSIONS BD with BPD has a more severe presentation of illness than BD alone. The results suggest that BPD is highly predictive of a future diagnosis of BD. Childhood traumatic experiences may have a role in understanding this relationship.
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Relationship between personality disorder functioning styles and the emotional states in bipolar I and II disorders. PLoS One 2015; 10:e0117353. [PMID: 25625553 PMCID: PMC4307975 DOI: 10.1371/journal.pone.0117353] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 12/23/2014] [Indexed: 11/20/2022] Open
Abstract
Background Bipolar disorder types I (BD I) and II (BD II) behave differently in clinical manifestations, normal personality traits, responses to pharmacotherapies, biochemical backgrounds and neuroimaging activations. How the varied emotional states of BD I and II are related to the comorbid personality disorders remains to be settled. Methods We therefore administered the Plutchick – van Praag Depression Inventory (PVP), the Mood Disorder Questionnaire (MDQ), the Hypomanic Checklist-32 (HCL-32), and the Parker Personality Measure (PERM) in 37 patients with BD I, 34 BD II, and in 76 healthy volunteers. Results Compared to the healthy volunteers, patients with BD I and II scored higher on some PERM styles, PVP, MDQ and HCL-32 scales. In BD I, the PERM Borderline style predicted the PVP scale; and Antisocial predicted HCL-32. In BD II, Borderline, Dependant, Paranoid (-) and Schizoid (-) predicted PVP; Borderline predicted MDQ; Passive-Aggressive and Schizoid (-) predicted HCL-32. In controls, Borderline and Narcissistic (-) predicted PVP; Borderline and Dependant (-) predicted MDQ. Conclusion Besides confirming the different predictability of the 11 functioning styles of personality disorder to BD I and II, we found that the prediction was more common in BD II, which might underlie its higher risk of suicide and poorer treatment outcome.
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Fonseka TM, Swampillai B, Timmins V, Scavone A, Mitchell R, Collinger KA, Goldstein BI. Significance of borderline personality-spectrum symptoms among adolescents with bipolar disorder. J Affect Disord 2015; 170:39-45. [PMID: 25233237 DOI: 10.1016/j.jad.2014.08.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 07/27/2014] [Accepted: 08/12/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known regarding correlates of borderline personality-spectrum symptoms (BPSS) among adolescents with bipolar disorder (BP). METHODS Participants were 90 adolescents, 13-19 years of age, who fulfilled DSM-IV-TR criteria for BP using semi-structured diagnostic interviews. BPSS status was ascertained using the Life Problems Inventory which assessed identity confusion, interpersonal problems, impulsivity, and emotional lability. Analyses compared adolescents with "high" versus "low" BPSS based on a median split. RESULTS Participants with high, relative to low, BPSS were younger, and had greater current and past depressive episode severity, greater current hypo/manic episode severity, younger age of depression onset, and reduced global functioning. High BPSS participants were more likely to have BP-II, and had higher rates of social phobia, generalized anxiety disorder, conduct disorder, oppositional defiant disorder, homicidal ideation, assault of others, non-suicidal self-injury, suicidal ideation, and physical abuse. Despite greater illness burden, high BPSS participants reported lower rates of lithium use. The most robust independent predictors of high BPSS, identified in multivariate analyses, included lifetime social phobia, non-suicidal self-injury, reduced global functioning, and conduct and/or oppositional defiant disorder. LIMITATIONS The study design is cross-sectional and cannot determine causality. CONCLUSIONS High BPSS were associated with greater mood symptom burden and functional impairment. Presence of high BPSS among BP adolescents may suggest the need to modify clinical monitoring and treatment practices. Future prospective studies are needed to examine the direction of observed associations, the effect of treatment on BPSS, and the effect of BPSS as a moderator or predictor of treatment response.
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Affiliation(s)
- Trehani M Fonseka
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Brenda Swampillai
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Vanessa Timmins
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Antonette Scavone
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Rachel Mitchell
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Katelyn A Collinger
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Benjamin I Goldstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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Jansen K, Cardoso TDA, Mondin TC, Matos MBD, Souza LDDM, Pinheiro RT, Magalhães PVDS, Silva RAD. Eventos de vida estressores e episódios de humor: uma amostra comunitária. CIENCIA & SAUDE COLETIVA 2014; 19:3941-6. [DOI: 10.1590/1413-81232014199.12932013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/08/2013] [Indexed: 11/21/2022] Open
Abstract
Transtornos de humor são consequentes de uma interação entre fatores biológicos e ambientais. O objetivo deste estudo foi identificar associações entre eventos vitais estressores e transtornos de humor em uma amostra comunitária de jovens do Sul do Brasil. Trata-se de estudo transversal de base populacional com jovens de 18 a 24 anos. A seleção da amostra foi realizada por conglomerados. Os episódios de alteração do humor foram avaliados através da Mini International Neuropsychiatric Interview , enquanto os eventos vitais estressores foram mensurados através da escala de reajustamento social de Holmes e Rahe. A amostra foi de 1172 jovens. A proporção de eventos vitais estressores no último ano, em cada categoria, no total da amostra, foi de: 53,8% trabalho, 42,4% perda de suporte social, 63,8% família, 50,9% mudanças ambientais, 61,1% dificuldades pessoais e 38,7% finanças. Houve associação significativa entre eventos vitais estressores e episódios de alteração de humor. Foi verificada maior ocorrência de eventos vitais estressores entre os jovens em episódio misto, quando comparados aos jovens em episódio depressivo, (hipo) maníaco e controles. Esses achados sugerem uma interação psicossocial entre eventos vitais estressores e os episódios de alteração de humor.
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Umamaheswari V, Avasthi A, Grover S. Risk factors for suicidal ideations in patients with bipolar disorder. Bipolar Disord 2014; 16:642-51. [PMID: 24467510 DOI: 10.1111/bdi.12179] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 08/29/2013] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify the risk factors for suicidal ideation in subjects with bipolar depression. METHODS One-hundred and thirty subjects diagnosed with bipolar depression were evaluated on the following scales: Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Patient Health Questionnaire-15 (PHQ-15), Barrat's Impulsivity Scale (BIS), Irritability, Anxiety, and Depression (IDA) Scale, Young Mania Rating Scale (YMRS), Buss-Durke Hostile Inventory (BDHI), and Brief Psychiatric Rating Scale (BPRS). RESULTS Based on the BDI suicidal thoughts and wishes item (score of ≥ 1), the study sample was divided into those with and those without suicidal ideation. Compared to those without suicidal ideations, patients with bipolar depression with suicidal ideation had significantly higher scores on the BDI, YMRS, BPRS total score, IDA total score, PHQ-15, BHS total score, and most of the hostility subscales of the BHI. [corrected]. On binary logistic regression analysis, the odds ratio (OR) for [corrected] presence of suicidal ideations was more than one and was significant for the BHS [OR = 1.53, [corrected] 95% confidence interval (CI): 1.24-1.99], the IDA-irritability directed inwards (OR = 1.48, 95% CI: 1.03-2.13), and the total hostility score (OR = 1.10, 95% CI: 1.02-1.20). Other factors for which the OR was more than one but the difference was not statistically significant were: Hindu religion (OR = 3.13, 95% CI: 0.76-12.99), lifetime mean duration of depressive episodes (OR = 1.08, 95% CI: 0.74-1.57), past history of hospitalization (OR = 1.10, 95% CI: 0.24-6.16), any preceding life events (OR = 1.45, 95% CI: 0.28-7.52), subsyndromal manic symptoms (OR = 1.01, 95% CI:0.53-1.92), presence of psychotic symptoms (OR = 1.06, 95% CI: 0.92-1.22), and irritability directed outwards (OR = 1.14, 95% CI: 0.92-1.41). [corrected]. CONCLUSION Among the various predictors of suicidal ideations, the severity of hopelessness, irritability directed inwards, and hostility are the most important risk factors for suicidal ideations in patients with bipolar disorder. [corrected]. Hence, patients with these risk factors should be closely monitored to prevent suicide attempts and completed suicides.
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Affiliation(s)
- Vanamoorthy Umamaheswari
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Päären A, Bohman H, von Knorring AL, von Knorring L, Olsson G, Jonsson U. Hypomania spectrum disorder in adolescence: a 15-year follow-up of non-mood morbidity in adulthood. BMC Psychiatry 2014; 14:9. [PMID: 24428938 PMCID: PMC3898212 DOI: 10.1186/1471-244x-14-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/08/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND We investigated whether adolescents with hypomania spectrum episodes have an excess risk of mental and physical morbidity in adulthood, as compared with adolescents exclusively reporting major depressive disorder (MDD) and controls without a history of adolescent mood disorders. METHODS A community sample of adolescents (N = 2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes (40 full-syndromal, 18 with brief episode, and 32 subsyndromal), while another 197 fulfilled the criteria for MDD without a history of a hypomania spectrum episode. A follow up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. The participation rate at the follow-up interview was 71% (64/90) for the hypomania spectrum group, and 65.9% (130/197) for the MDD group. Multiple imputation was used to handle missing data. RESULTS The outcomes of the hypomania spectrum group and the MDD group were similar regarding subsequent non-mood Axis I disorders in adulthood (present in 53 vs. 57%). A personality disorder was reported by 29% of the hypomania spectrum group and by 20% of the MDD group, but a statistically significant difference was reached only for obsessive-compulsive personality disorder (24 vs. 14%). In both groups, the risk of Axis I disorders and personality disorders in adulthood correlated with continuation of mood disorder. Prescription drugs and health service use in adulthood was similar in the two groups. Compared with adolescents without mood disorders, both groups had a higher subsequent risk of psychiatric morbidity, used more mental health care, and received more psychotropic drugs. CONCLUSIONS Although adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes, both groups are at increased risk for subsequent mental health problems. Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course.
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Affiliation(s)
- Aivar Päären
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Hannes Bohman
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Anne-Liis von Knorring
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Lars von Knorring
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Gunilla Olsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Ulf Jonsson
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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Wenze SJ, Gaudiano BA, Weinstock LM, Miller IW. Personality pathology predicts outcomes in a treatment-seeking sample with bipolar I disorder. DEPRESSION RESEARCH AND TREATMENT 2014; 2014:816524. [PMID: 24516762 PMCID: PMC3910300 DOI: 10.1155/2014/816524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/01/2013] [Accepted: 10/08/2013] [Indexed: 11/25/2022]
Abstract
We conducted a secondary analysis of data from a clinical trial to explore the relationship between degree of personality disorder (PD) pathology (i.e., number of subthreshold and threshold PD symptoms) and mood and functioning outcomes in Bipolar I Disorder (BD-I). Ninety-two participants completed baseline mood and functioning assessments and then underwent 4 months of treatment for an index manic, mixed, or depressed phase acute episode. Additional assessments occurred over a 28-month follow-up period. PD pathology did not predict psychosocial functioning or manic symptoms at 4 or 28 months. However, it did predict depressive symptoms at both timepoints, as well as percent time symptomatic. Clusters A and C pathology were most strongly associated with depression. Our findings fit with the literature highlighting the negative repercussions of PD pathology on a range of outcomes in mood disorders. This study builds upon previous research, which has largely focused on major depression and which has primarily taken a categorical approach to examining PD pathology in BD.
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Affiliation(s)
- Susan J. Wenze
- Alpert Medical School of Brown University and Butler Hospital, Psychosocial Research, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Brandon A. Gaudiano
- Alpert Medical School of Brown University and Butler Hospital, Psychosocial Research, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Lauren M. Weinstock
- Alpert Medical School of Brown University and Butler Hospital, Psychosocial Research, 345 Blackstone Boulevard, Providence, RI, 02906, USA
| | - Ivan W. Miller
- Alpert Medical School of Brown University and Butler Hospital, Psychosocial Research, 345 Blackstone Boulevard, Providence, RI, 02906, USA
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Abstract
PURPOSE OF REVIEW Differentiating bipolar II disorder (BP II) from borderline personality disorder (BPD) is a common diagnostic dilemma. The purpose of this review is to focus on recent studies that have considered clinical differences between the conditions including family history, phenomenology, longitudinal course, comorbidity and treatment response, and which might advance their clinical distinction. RECENT FINDINGS Findings suggest key differentiating parameters to include family history, onset pattern, clinical course, phenomenological profile of depressive and elevated mood states, and symptoms of emotional dysregulation. Less specific differentiation is provided by childhood trauma history, deliberate self-harm, comorbidity rates, neurocognitive features, treatment response and impulsivity parameters. SUMMARY This review refines candidate variables for differentiating BP II from BPD, and should assist the design of studies seeking to advance their phenomenological and clinical distinction.
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Jiménez E, Arias B, Mitjans M, Goikolea JM, Roda E, Sáiz PA, García-Portilla MP, Burón P, Bobes J, Oquendo MA, Vieta E, Benabarre A. Genetic variability at IMPA2, INPP1 and GSK3β increases the risk of suicidal behavior in bipolar patients. Eur Neuropsychopharmacol 2013; 23:1452-62. [PMID: 23453640 DOI: 10.1016/j.euroneuro.2013.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 11/20/2012] [Accepted: 01/27/2013] [Indexed: 11/16/2022]
Abstract
Bipolar patients (BP) are at high risk of suicide. Causal factors underlying suicidal behavior are still unclear. However, it has been shown that lithium has antisuicidal properties. Genes involved in its putative mechanism of action such as the phosphoinositol and the Wnt/β-catenine pathways could be considered candidates for suicidal behavior (SB). Our aim was to investigate the association of the IMPA1 and 2, INPP1, GSK3α and β genes with suicidal behavior in BP. 199 BP were recruited. Polymorphisms at the IMPA1 (rs915, rs1058401 and rs2268432) and IMPA2 (rs66938, rs1020294, rs1250171 and rs630110), INPP1 (rs3791809, rs4853694 and 909270), GSK3α (rs3745233) and GSK3β (rs334558, rs1732170 and rs11921360) genes were genotyped. All patients were grouped and compared according to the presence or not of history of SB (defined as the presence of at least one previous suicidal attempt). Single SNP analyses showed that suicide attempters had higher frequencies of AA genotype of the rs669838-IMPA2 and GG genotype of the rs4853694-INPP1gene compared to non-attempters. Results also revealed that T-allele carriers of the rs1732170-GSK3β gene and A-allele carriers of the rs11921360-GSK3β gene had a higher risk for attempting suicide. Haplotype analysis showed that attempters had lower frequencies of A:A haplotype (rs4853694:rs909270) at the INPP1 gene. Higher frequencies of the C:A haplotype and lower frequencies of the A:C haplotype at the GSK-3β gene (rs1732170:rs11921360) were also found to be associated to SB in BP. Therefore, our results suggest that genetic variability at IMPA2, INPP1 and GSK3β genes is associated with the emergence of SB in BP.
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Affiliation(s)
- E Jiménez
- Bipolar Disorder Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
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Antoniadis D, Samakouri M, Livaditis M. The association of bipolar spectrum disorders and borderline personality disorder. Psychiatr Q 2012; 83:449-65. [PMID: 22392448 DOI: 10.1007/s11126-012-9214-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Bipolar disorder (BD) and borderline personality disorder (BPD) are two different entities sharing a variety of common features in a number of fields and, thus, presenting difficulties in their differential diagnosis. The aim of the review is to identify similarities and differences between BD and BPD concerning the symptomatology, causes, course and treatment of the two disorders. A systematic electronic search of Pubmed (Medline) was conducted in order to identify all relevant scientific articles published between 1990 and 2010. The main common clinical features of BD and BPD are affective instability and impulsivity, which, however, present with quality differences in each disorder. In the field of neuroanatomy, BD and BPD demonstrate similarities such as alterations in the limbic system, as well as specific differences, such as the increase in size of the amygdala in BD and the decrease in BPD. Both disorders appear to have a significant percentage of heritability, but environmental factors seem to hold an important role in BPD, in particular. Both BD and BPD are affected by alterations in the dopaminergic and serotonergic system. Fuctionability and prognosis are slightly worse for BPD. Concerning medication treatment, antidepressants are considered effective in BPD, whereas mood stabilizers are the main treatment of choice in BD. The effectiveness of a variety of psychotherapeutic methods is still under research for both disorders. Despite the similarities and differences already being traced in clinical and biological fields, the relationship of the two disorders has not yet been thoroughly defined.
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Affiliation(s)
- Diomidis Antoniadis
- Department of Psychiatry, School of Medicine, Democritus University of Thrace, Alexandroupoli, Greece.
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Prevalence of personality disorders using two diagnostic systems in psychiatric outpatients in Shanghai, China: a comparison of uni-axial and multi-axial formulation. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1409-17. [PMID: 22160097 PMCID: PMC4144990 DOI: 10.1007/s00127-011-0445-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2010] [Accepted: 10/17/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To compare multi-axial (DSM-IV) with uni-axial diagnostic system (CCMD-3, Chinese Classification and Diagnostic Criteria of Mental Disorders) as diagnostic methods to determine the prevalence of personality disorders (PDs) in Chinese psychiatric outpatients. METHOD 3,075 outpatients were randomly sampled from clinical settings in China. CCMD-3 PDs were evaluated as per routine psychiatric practice. DSM-IV PDs were assessed using both self-reported questionnaire and structured clinical interview. RESULTS The prevalence estimate for any type of PD in the total sample is 31.93% as reflected in the DSM-IV. This figure is nearly 110 times as large as the prevalence estimate for the CCMD-3. Only 9 outpatients were diagnosed with PD based on the CCMD-3. Amongst the 10 forms of DSM-IV PDs, avoidant (8.1%), obsessive-compulsive (7.6%), paranoid (6.0%), and borderline (5.8%) PDs were the most prevalent subtypes. This study found that PDs are commonly associated with the following: (i) the younger aged; (ii) single marital status; (iii) those who were not raised by their parents; (iv) introverted personalities; (v) first-time seekers of psycho-counseling treatment; and (vi) patients with co-morbid mood or anxiety disorders. CONCLUSIONS PDs are easily overlooked when the diagnosis is made based on the CCMD-3 uni-axial diagnostic system. However, it was found that personality pathology is common in the Chinese psychiatric community when using the DSM-IV classification system. Existing evidence suggest, at least indirectly, that there are important benefits of moving towards a multi-axial diagnostic approach in psychiatric practice.
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Coulston CM, Tanious M, Mulder RT, Porter RJ, Malhi GS. Bordering on bipolar: the overlap between borderline personality and bipolarity. Aust N Z J Psychiatry 2012; 46:506-21. [PMID: 22510555 DOI: 10.1177/0004867412445528] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE There is much debate over whether borderline personality disorder (BPD) belongs to the bipolar spectrum. The diagnosis of bipolar disorder (BD) in BPD patients, and conversely, BPD in BD patients is common, indicating prevalent co-morbidity, as well as potential misdiagnosis in either group. BD and BPD are often indistinguishable given the core characteristics of emotional dysregulation and impulsivity that feature in both. However, it may be argued that the manifestation of these characteristics in the two groups is different, and that the symptoms are driven by distinct aetiological factors. The primary objective of this paper was to examine where potential areas of discrimination lie between BD and BPD. METHODS A literature search was conducted using MEDLINE and PubMed databases to identify studies that have researched BD and BPD across the recognised domains of emotional dysregulation, impulsivity, childhood trauma, and their putative neurobiological substrates. RESULTS Research comparing BD and BPD patients on self-report measures is limited, and no studies have examined their neurobiological underpinnings in the same design. One possible differentiating variable is childhood trauma which shapes the circumstances in which emotional dysregulation and impulsivity are triggered, the types of behaviours exhibited, and the frequency and duration of mood states. There is growing evidence that childhood trauma not only predisposes individuals to both disorders, but also modulates the clinical expression and course of bipolar illness, particularly rapid cycling BD, a form of bipolarity that resembles the clinical profile of BPD, yet presents quite distinctly from other BD subtypes. CONCLUSIONS This paper provides an overview of BD and BPD with respect to emotional dysregulation, impulsivity, childhood factors, and neurobiological substrates. Based on findings predominantly within the independent areas of BD and BPD, it tentatively provides an integrated behavioural, aetiological and neurobiological approach for investigating the question of whether BPD belongs to the bipolar spectrum.
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Affiliation(s)
- Carissa M Coulston
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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25
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Abstract
BACKGROUND Research suggests that current diagnostic criteria for bipolar disorders may fail to include milder, but clinically significant, bipolar syndromes and that a substantial percentage of these conditions are diagnosed, by default, as unipolar major depression. Accordingly, a number of researchers have argued for the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to better account for subsyndromal hypomanic presentations. METHODS The present paper is a critical review of research on subthreshold bipolarity, and an assessment of some of the challenges that researchers and clinicians might face if the DSM-5 were designed to systematically document subsyndromal hypomanic presentations. RESULTS Individuals with major depressive disorder (MDD) who display subsyndromal hypomanic features, not concurrent with a major depressive episode, have a more severe course compared to individuals with MDD and no hypomanic features, and more closely resemble individuals with bipolar disorder on a number of clinical validators. CONCLUSION There are clinical and scientific reasons for systematically documenting subsyndromal hypomanic presentations in the assessment and diagnosis of mood disorders. However, these benefits are balanced with important challenges, including (i) the difficulty in reliably identifying subsyndromal hypomanic presentations, (ii) operationalizing subthreshold bipolarity, (iii) differentiating subthreshold bipolarity from borderline personality disorder, (iv) the risk of over-diagnosing bipolar spectrum disorders, and (v) uncertainties about optimal interventions for subthreshold bipolarity.
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Affiliation(s)
- Robin Nusslock
- Department of Psychology, Northwestern University, Evanston, IL 60208, USA.
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Solé B, Martínez-Arán A, Torrent C, Bonnin CM, Reinares M, Popovic D, Sánchez-Moreno J, Vieta E. Are bipolar II patients cognitively impaired? A systematic review. Psychol Med 2011; 41:1791-1803. [PMID: 21275085 DOI: 10.1017/s0033291711000018] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is evidence that bipolar disorder (BD) is associated with significant neurocognitive deficits and this occurs in individuals with BD type I (BD I) and with BD type II (BD II). Only a few studies have focused on cognitive impairment in BD II. The aim of this study was to describe the pattern of cognitive impairment in patients with BD II, in order to identify specific cognitive deficits that distinguish BD II from BD I patients as well as from healthy subjects. METHOD We performed a systematic review of the literature of neuropsychological studies of BD II published between 1980 and July 2009. Fourteen articles fulfilled the inclusion criteria and were included in this review. RESULTS Main cognitive deficits found in BD II include working memory and some measures of executive functions (inhibitory control) and approximately half of the studies also detected verbal memory impairment. CONCLUSIONS There are subtle differences between the two subtypes regarding cognition. This may suggest neurobiological differences between the two subgroups which will be helpful in order to determine cognitive endophenotypes in BD subtypes.
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Affiliation(s)
- B Solé
- Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
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Neurocognitive impairments and their relationship with psychosocial functioning in euthymic bipolar II disorder. J Nerv Ment Dis 2011; 199:459-64. [PMID: 21716059 DOI: 10.1097/nmd.0b013e3182214190] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of this study was to compare neurocognitive functioning between euthymic patients with bipolar I disorder (BDI), bipolar II disorder (BDII), and healthy controls. An additional aim was to estimate the relationship between neurocognitive impairments and psychosocial functioning. Eighty-seven patients with BDI (n = 48) or BDII (n = 39) and 39 healthy controls were included. All subjects completed an extensive neurocognitive battery. Psychosocial functioning was assessed using the General Assessment of Functioning. Patients with BDII performed more poorly than did the controls in measures of psychomotor speed, verbal memory, and executive functioning. Patient groups did not show differences in any of the cognitive measures assessed. The performance in trail-making test B was the only independent predictor of psychosocial functioning in both patient groups. Patients with BDII have cognitive impairments, and this has a negative influence on their functional outcome. Our results bring additional support to the notion that BDII disorder is not a merely mild type of BDI.
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Okan Ibiloglu A, Caykoylu A. The comorbidity of anxiety disorders in bipolar I and bipolar II patients among Turkish population. J Anxiety Disord 2011; 25:661-7. [PMID: 21411273 DOI: 10.1016/j.janxdis.2011.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 02/12/2011] [Accepted: 02/15/2011] [Indexed: 12/13/2022]
Abstract
High rates of anxiety disorders have been reported in bipolar disorders. The study aimed to investigate prevalence of anxiety disorders in remitted bipolar subjects and their influence on the illness severity. Bipolar subjects with anxiety disorders were younger, had earlier age at onset of illness, and were overrepresented by female subjects and those with earlier onset illness compared to those without anxiety disorder. The study demonstrated that (1) anxiety disorders are highly prevalent in bipolar subjects, (2) individual anxiety disorders, particularly SP and PD seem to have an effect on illness severity, (3) bipolar subjects with comorbid anxiety tend to have a poorer course and are less responsive to treatment, and (4) anxiety tends to be associated with an earlier age at onset of bipolar disorder (BPD) and results in a more complicated and severe disease course.
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Ryu V, Jon DI, Cho HS, Kim SJ, Lee E, Kim EJ, Seok JH. Initial depressive episodes affect the risk of suicide attempts in Korean patients with bipolar disorder. Yonsei Med J 2010; 51:641-7. [PMID: 20635436 PMCID: PMC2908881 DOI: 10.3349/ymj.2010.51.5.641] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Suicide is a major concern for increasing mortality in bipolar patients, but risk factors for suicide in bipolar disorder remain complex, including Korean patients. Medical records of bipolar patients were retrospectively reviewed to detect significant clinical characteristics associated with suicide attempts. MATERIALS AND METHODS A total of 579 medical records were retrospectively reviewed. Bipolar patients were divided into two groups with the presence of a history of suicide attempts. We compared demographic characteristics and clinical features between the two groups using an analysis of covariance and chi-square tests. Finally, logistic regression was performed to evaluate significant risk factors associated with suicide attempts in bipolar disorder. RESULTS The prevalence of suicide attempt was 13.1% in our patient group. The presence of a depressive first episode was significantly different between attempters and nonattempters. Logistic regression analysis revealed that depressive first episodes and bipolar II disorder were significantly associated with suicide attempts in those patients. CONCLUSION Clinicians should consider the polarity of the first mood episode when evaluating suicide risk in bipolar patients. This study has some limitations as a retrospective study and further studies with a prospective design are needed to replicate and evaluate risk factors for suicide in patients with bipolar disorder.
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Affiliation(s)
- Vin Ryu
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Duk-In Jon
- Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyun Sang Cho
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Se Joo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Joo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Ho Seok
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
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How suicidal bipolar patients are depends on how suicidal ideation is defined. J Affect Disord 2009; 118:48-54. [PMID: 19282033 DOI: 10.1016/j.jad.2009.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 02/12/2009] [Accepted: 02/12/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Suicidal ideation indicates risk for suicidal acts. How different definitions and measures for suicidal ideation influence its prevalence, correlates and predictive validity among bipolar disorder (BD) patients is unknown. METHODS Among the 191 BD patients in the Jorvi Bipolar Study (JoBS), suicidal ideation at baseline was measured using the Scale for Suicidal Ideation (SSI), Hamilton Depression Scale (HAM-D) item 3 and Beck Depression Inventory (BDI) item 9 and by asking whether patients had seriously considered suicide. The predictive value of different definitions of ideation on suicide attempts during a six-month follow-up was investigated. RESULTS Altogether 74% of patients had suicidal ideation as defined in at least one of the above-mentioned ways, but only 29% met the criteria for all ways; agreement between definitions ranged from low to moderate (kappa coefficient 0.15 to 0.70). The correlates of suicidal ideation overlapped, but were not identical. Of the measures investigated, a baseline SSI score >or=8 had the best combination of sensitivity (0.81) and specificity (0.69) and a positive predictive value (PPV) of 32% for an attempted suicide during follow-up. LIMITATIONS All plausible measures for suicidal ideation could not be investigated. CONCLUSIONS Who is classified as having suicidal ideation depends strongly on the definition and means of measurement among BD patients. Different measures for ideation have the potential to cause inconsistency when correlates of suicidal ideation are investigated. For clinically predicting suicide attempts during the next few months, an SSI score >or=8 may best combine sensitivity and specificity.
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Abstract
Recent suggestions to extend the boundaries of bipolar disorder to a broader spectrum lead to a concept of bipolarity different from that of classical psychiatry. It has been proposed that many patients with unipolar depression are actually bipolar and that many cases of substance abuse, personality disorders, and childhood behavioral disorders lie within the spectrum. However, since this expanded notion of bipolarity has been defined entirely on the basis of phenomenology, any expansion needs to meet broader criteria for validity. Bipolar spectrum disorders have a different phenomenology, family history, and course than classical bipolar disorders and do not respond in the same way to drugs. Until further research clarifies the boundaries of bipolarity, we should be conservative about extending its scope.
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Affiliation(s)
- Joel Paris
- Department of Psychiatry, McGill University, Institute of Community and Family Psychiatry and Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Canada.
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Sánchez-Gistau V, Colom F, Mané A, Romero S, Sugranyes G, Vieta E. Atypical depression is associated with suicide attempt in bipolar disorder. Acta Psychiatr Scand 2009; 120:30-6. [PMID: 19183125 DOI: 10.1111/j.1600-0447.2008.01341.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is a dearth of research focusing on factors associated with suicide attempts. High rates of atypical depression have been reported in studies including unipolar and bipolar II patients. In this study, the association between suicide attempt and atypical depression, in addition to other major risk factors, was evaluated in 390 bipolar I and II out-patients. METHOD Variables were defined according to DSM-IV criteria, and assessed with a Structured Interview for DSM-IV (axis I and II). History of suicide attempt was obtained through interviews with patients and relatives. Attempters and non-attempters were compared using univariate and multivariate analysis. RESULTS Attempters showed significantly higher rates of atypical depression, family history of completed suicide, depression at index episode and cluster B personality disorder. CONCLUSION Our results highlight the relevance of atypical depression in bipolar disorder. A more accurate identification of potential attempters may contribute to the development of effective preventive treatment strategies.
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Affiliation(s)
- V Sánchez-Gistau
- Bipolar Disorders Program, Institute of Clinical Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Catalonia, Spain
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Rosso G, Albert U, Bogetto F, Maina G. Axis II comorbidity in euthymic bipolar disorder patients: no differences between bipolar I and II subtypes. J Affect Disord 2009; 115:257-61. [PMID: 18814915 DOI: 10.1016/j.jad.2008.08.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 08/11/2008] [Accepted: 08/11/2008] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bipolar disorder type II (BDII) has been considered since its distinction from bipolar disorder type I (BDI) as a milder form, on the basis of cross-sectional symptoms intensity. Longitudinal data, on the contrary, do suggest that it is at least as severe as BDI, if not even more chronic and impairing. Few studies investigated differences in Axis II comorbidity in bipolar disorder patients according to bipolar subtypes, and none examined patients during prolonged euthymia. The aim of the study was to determine comorbidity rates for personality disorders in euthymic bipolar subjects, comparing bipolar type I and II disorders (BDI and BDII). METHODS 186 DSM-IV (SCID-I) bipolar disorder subjects were enrolled; all patients were euthymic for at least two months, as confirmed by a HAM-D<8 and a YMRS<6. Axis II comorbidity was evaluated through SCID-II. Differences in Axis II comorbidity rates were examined with the Pearson's Chi-square test. RESULTS Of the subjects included, 71 had BDI and 115 BDII. At least a personality disorder was present in 42.5% of all bipolars, 43.7% of BDI and 41.7% of BDII. No differences were detected between the two subgroups for any single personality disorder. LIMITATIONS We relied only on the patients' reports in assessing personality disorders; the sample was made of subjects referred to a tertiary centre who were able to maintain euthymia. CONCLUSIONS Our study confirms the high comorbidity rates for personality disorders in bipolar subjects and provides evidence that BDII, with regard to Axis II comorbidity, is as severe as BDI.
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Affiliation(s)
- Gianluca Rosso
- Department of Neurosciences, Mood and Anxiety Disorders Unit, University of Turin, Via Cherasco 11-10126 Torino, Italy
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Tafalla M, Sanchez-Moreno J, Diez T, Vieta E. Screening for bipolar disorder in a Spanish sample of outpatients with current major depressive episode. J Affect Disord 2009; 114:299-304. [PMID: 18701169 DOI: 10.1016/j.jad.2008.06.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2008] [Revised: 06/27/2008] [Accepted: 06/28/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Bipolar spectrum disorders often go unrecognised and undiagnosed or misdiagnosed. One of the underlying reasons is the poor recognition of bipolar disorder among patients presenting depressive episodes. The specific aim of this study was to estimate the Mood Disorder Questionnaire (MDQ) rate of positive screens for bipolar disorder in a Spanish sample of outpatients with a current major depressive episode and compare it with their current psychiatric diagnosis. The study was designed to address this specific question. METHOD 971 consecutively outpatients with a current DSM-IV TR diagnosis of a major depressive episode entered this cross-sectional study. Study measures included sociodemographic and clinical data, Clinical Global Impression of Severity of Illness Scale (CGI-S), Hamilton Depression Scale (HAMD) and MDQ. RESULTS 905 patients fulfilled criteria to be included in the analysis. All of them presented with a current major depressive episode. 74.3% (n=671) of the patients had received a diagnosis of unipolar depression and 25.7% (n=232) of bipolar disorder by a psychiatrist. Using a MDQ of 7-or-more-item threshold, the global positive screen rate for bipolar disorder was 41.3% (n=373). From the 671 patients with previous unipolar depression diagnosis, 161 (24%) screened positive for bipolar disorder with MDQ, whereas in 232 patients diagnosed of bipolar disorder, 212 (91.4%) screened positive for bipolar disorder. CONCLUSIONS The MDQ showed a positive screen rate for bipolar disorder in 24% of patients with a previous diagnosis of unipolar disorder and a current major depressive episode. Screening tools like MDQ could contribute to increase detection of bipolar disorder in patients with depression. Early diagnosis of bipolar disorder may have important clinical and therapeutic implications in order to improve the illness course and the long-term functional outcome.
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Affiliation(s)
- M Tafalla
- Medical Department, AstraZeneca, Madrid, Spain
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Abstract
OBJECTIVE As a commitment to the International Society for Bipolar Disorders (ISBD), a Task Force was developed to investigate the diagnostic value of bipolar II disorder. METHODS Task Force members worked jointly reviewing all relevant literature (original articles, reviews, letters, book chapters and congress presentations) that included 'bipolar II disorder' and/or 'hypomania' as key words. RESULTS Bipolar II disorder appears to be a reasonably valid and reliable diagnostic category yet often underdiagnosed or misdiagnosed as unipolar disorder or personality disorder. Moreover, it is officially recognized as a mental disorder in DSM-IV-TR but not in ICD-10, and many clinicians still regard it as a milder form of manic-depressive illness, despite data supporting high morbidity and mortality rates. In fact, bipolar II may be the most prevalent bipolar phenotype, although current diagnostic boundaries are seen as quite restrictive concerning the required duration for hypomania (4 days), the exclusion of hypomanic episodes potentially triggered by antidepressants and other substances, and the negligence of hypomanic mixed states. The course of bipolar II disorder is characterized by depressive predominant polarity, and its treatment is still controversial and poorly evidence-based. CONCLUSIONS Bipolar II disorder is supported as a distinct category within mood disorders, but the definition and boundaries deserve a greater clarification in the DSM-V and ICD-11.
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Affiliation(s)
- Eduard Vieta
- Bipolar Disorders Program, Hospital Clinic, University of Barcelona, IDIBAPS, CIBER-SAM, Barcelona, Spain.
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Abstract
OBJECTIVES Relatively few systematic data exist on the clinical impact of bipolar comorbidity in obsessive-compulsive disorder (OCD) and no studies have investigated the influence of such a comorbidity on the prevalence and pattern of Axis II comorbidity. The aim of the present study was to explore the comorbidity of personality disorders in a group of patients with OCD and comorbid bipolar disorder (BD). METHODS The sample consisted of 204 subjects with a principal diagnosis of OCD (DSM-IV) and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score>or=16 recruited from all patients consecutively referred to the Anxiety and Mood Disorders Unit, Department of Neuroscience, University of Turin over a period of 5 years (January 1998-December 2002). Diagnostic evaluation and Axis I comorbidities were collected by means of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Personality status was assessed by using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Socio-demographic and clinical features (including Axis II comorbidities) were compared between OCD patients with and without a lifetime comorbidity of BD. RESULTS A total of 21 patients with OCD (10.3%) met DSM-IV criteria for a lifetime BD diagnosis: 4 (2.0%) with BD type I and 17 (8.3%) with BD type II. Those without a BD diagnosis showed significantly higher rates of male gender, sexual and hoarding obsessions, repeating compulsions and lifetime comorbid substance use disorders, when compared with patients with BD/OCD. With regard to personality disorders, those with BD/OCD showed higher prevalence rates of Cluster A (42.9% versus 21.3%; p=0.027) and Cluster B (57.1% versus 29.0%; p=0.009) personality disorders. Narcissistic and antisocial personality disorders were more frequent in BD/OCD. CONCLUSIONS Our results point towards clinically relevant effects of comorbid BD on the personality profiles of OCD patients, with higher rates of narcissistic and antisocial personality disorders in BD/OCD patients.
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Affiliation(s)
- Giuseppe Maina
- Department of Neuroscience, Anxiety and Mood Disorders Unit, University of Turin, Turin, Italy.
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Agren H, Backlund L. Bipolar disorder: Balancing mood states early in course of illness effects long-term prognosis. Physiol Behav 2007; 92:199-202. [PMID: 17631368 DOI: 10.1016/j.physbeh.2007.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The importance of observing swings above euthymic normality in patients with affective disorders has been emphasized by many research groups. The concept of mood bipolarity has not only established a Bipolar II disorder (with only hypomania, not mania, but also opened up for discussion of a Bipolar Spectrum, that would necessitate treatment with a broader range of agents, i.e., not only antidepressants. In order to understand the determinants of the patterns of mood swings in individuals with bipolar disorder we have used a computerized life-charting technique to analyze a large amount of clinical information in 100 patients with bipolar mood swings. In a cross-sectional set-up, we demonstrate clear evidence of achieving a better long-term stabilization when starting patients on mood stabilizer early after the first evidence of the mood disorder.
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Affiliation(s)
- Hans Agren
- Karolinska Institutet, Department of Clinical Neuroscience, Karolinska University Hospital Huddinge, Stockholm, Sweden.
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Paris J, Gunderson J, Weinberg I. The interface between borderline personality disorder and bipolar spectrum disorders. Compr Psychiatry 2007; 48:145-54. [PMID: 17292705 DOI: 10.1016/j.comppsych.2006.10.001] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE This review examines whether borderline personality disorder (BPD) should be considered part of the bipolar spectrum. METHODS A literature review examined studies of co-occurrence, phenomenology, family prevalence, medication response, longitudinal course, and etiology. RESULTS Borderline personality disorder and bipolar disorder co-occur, but their relationship is not consistent or specific. There are overlaps but important differences in phenomenology and in medication response. Family studies suggest clear distinctions, and it is unusual for BPD to evolve into bipolar disorder. Research is insufficient to establish whether these disorders have a common etiology. CONCLUSIONS Existing data fail to support the conclusion that BPD and bipolar disorders exist on a spectrum but allows for the possibility of partially overlapping etiologies.
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Affiliation(s)
- Joel Paris
- Department of Psychiatry, Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, McGill University, Montreal, Québec, Canada H3T 1E4.
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Abstract
OBJECTIVES To review the current knowledge of bipolar II disorder. METHODS Literature was reviewed after conducting a Medline search and a hand search of relevant literature. RESULTS Bipolar II disorder is a common disorder, with a prevalence of approximately 3-5%. Distinct clinical features of bipolar II disorder have been described. The key to diagnosis is the recognition of past hypomania, while depression is the typical presenting feature of the illness. This is responsible for a significant rate of missed diagnosis, and consequent management according to unipolar guidelines. It is unclear if bipolar II disorder is over-represented amongst resistant depression populations and if abrupt offset of antidepressant action is a phenomenon over represented in bipolar II disorder, reflecting induction of predominantly depressive cycling. A few mood-stabilizer studies available provide provisional suggestion of utility. A supportive role for psychosocial therapies is suggested, however, there is a sparsity of published studies specific to bipolar II disorder cohorts. A small number of short-term antidepressant trials have suggested efficacy, however, compelling long-term maintenance data is absent. CONCLUSIONS An emerging literature on the specific clinical signature and management of the disorder exists, however, this is disproportionately small relative to the epidemiology and clinical significance of the disorder.
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Affiliation(s)
- Michael Berk
- Department of Clinical and Biomedical Sciences, University of Melbourne, Swanston Centre, Geelong, Victoria, Australia.
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Schiavone P, Dorz S, Conforti D, Scarso C, Borgherini G. Comorbidity of DSM-IV Personality Disorders in unipolar and bipolar affective disorders: a comparative study. Psychol Rep 2004; 95:121-8. [PMID: 15460367 DOI: 10.2466/pr0.95.1.121-128] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to compare the prevalence of Personality Disorders assessed by Structured Clinical Interview for Axis-II in 155 inpatients diagnosed with Unipolar Disorder vs inpatients with Bipolar Disorder (39). The most frequent Axis II diagnoses among Unipolar inpatients were Borderline (31.6%), Dependent (25.2%), and Obsessive-Compulsive (14.2%) Personality Disorders. Among Bipolar inpatients, the most prevalent personality disorders were Borderline (41%), Narcissistic (20.5%), Dependent (12.8%), and Histrionic disorders (10.3%). Using chi squared analysis, few differences in distribution emerged between the two groups: Unipolar patients had more recurrent Obsessive-Compulsive Personality Disorder than Bipolar patients (chi(1)2=6.24, p<.005). Comorbid Narcissistic Personality Disorder was significantly more frequent in the Bipolar than in the Unipolar group (chi(1)2=6.34, P<.01). Considering the three clusters (DSM-IV classification), there was a significant difference between the groups, Cluster C (fearful, avoidant) diagnoses being more frequent in the Unipolar than in the Bipolar group (48.4% vs 20.5%, respectively). Cluster B (dramatic, emotionally erratic) diagnoses were found more frequently in patients with Bipolar Disorders (71.8% vs 45.2% in Unipolar patients, chi(2)2=10.1, p<.006). The differences in the distribution and prevalence of Personality Disorders between the two patient groups are discussed.
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Affiliation(s)
- Paolo Schiavone
- Affective Disorders Unit, Casa di Cura Parco dei Tigli, Padova, Italy
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Colom F, Vieta E, Sánchez-Moreno J, Martínez-Arán A, Torrent C, Reinares M, Goikolea JM, Benabarre A, Comes M. Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disord 2004; 6:294-8. [PMID: 15225146 DOI: 10.1111/j.1399-5618.2004.00127.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The co-occurrence of personality and bipolar disorders is quite common. Bipolar patients with personality disorders have been described as having poorer outcome than 'pure' bipolar patients. However, from a combined-approach point of view, a little has been done to improve the course of these patients. Psychoeducation has shown its efficacy in the prevention of relapses in the bipolar population but, to date, no data is available on its efficacy in the management of bipolar patients with personality disorders. METHOD The present study shows a subanalysis from a single-blind randomized prospective clinical trial on the efficacy of group psychoeducation in bipolar I patients. Bipolar patients fulfilling DSM-IV criteria for any personality disorder were randomized to either psychoeducational treatment or a non-structured intervention. There were 22 patients in the control group and 15 in the psychoeducation group. All patients received naturalistic pharmacological treatment as well. The follow-up phase comprised 2 years where all patients continued receiving naturalistic treatment without psychological intervention and were assessed monthly for several outcome measures. RESULTS At the end of the follow-up phase (2 years), a 100% of control group patients fulfilled criteria for recurrence versus a 67% in the psychoeducation group (p < 0.005). Patients included in the psychoeducation group had a higher time-to-relapse and a significantly lower mean number of total, manic and depressive relapses. No significant differences regarding the number of patients who required hospitalization were found but the mean duration of days spent in the hospitalization room was significantly higher for the patients included in the control group. CONCLUSION Psychoeducation may be a useful intervention for bipolar patients with comorbid personality disorders. Further studies should address the efficacy of specifically tailored interventions for this common type of patients.
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Affiliation(s)
- Francesc Colom
- Bipolar Disorders Program, Hospital Clinic University of Barcelona, IDIBAPS, Spain
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Tamam L, Ozpoyraz N, Karatas G. Personality disorder comorbidity among patients with bipolar I disorder in remission. Acta Neuropsychiatr 2004; 16:175-80. [PMID: 26984171 DOI: 10.1111/j.1601-5215.2004.00074.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Comorbid personality disorders have been shown to be a prominent factor affecting symptom severity and course in bipolar disorder (BD) patients. Bipolar patients with personality disorder had more relapses, poorer prognosis and worse treatment response than those without an axis II diagnosis. OBJECTIVE We evaluated the prevalence rate of comorbid personality disorder in 74 bipolar I disorder cases who were in remission and tried to elucidate the possible relationship between comorbid axis II disorders and prognosis, severity and treatment features of BD cases. METHODS Diagnosis of all personality disorder comorbidities was evaluated using the Structured Clinical Interview for DSM-III-R Axis-II Disorders (SCID-II), while the general psychopathology level was assessed using the Symptom Check List (SCL-90-R). A questionnaire for acquiring sociodemographic and clinical variables was also used. RESULTS Sixty-two per cent of bipolar I patients in this sample had at least one comorbid axis II disorder. The most common comorbid cluster of personality disorder was cluster C (48.6%), followed by cluster A (25.7%) and cluster B (20.3%) personality disorders. Assessment of demographic and clinical variables revealed that bipolar patients with comorbid personality disorder were mainly female, had multiple affective episodes, and had attempted suicide more often than patients without personality disorder. CONCLUSIONS The results of this study suggest that comorbid personality disorder might alter the course of BD and result in a poorer prognosis and more severe psychopathology. Further prospective controlled studies minimizing the bias of interviewers and other confounding factors would help us to understand the pure impact of personality disorder on the course of BD, its prognosis and response to treatment.
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Affiliation(s)
- Lut Tamam
- 1Cukurova University Faculty of Medicine, Department of Psychiatry, Adana, Turkey
| | - Nurgul Ozpoyraz
- 1Cukurova University Faculty of Medicine, Department of Psychiatry, Adana, Turkey
| | - Gonca Karatas
- 1Cukurova University Faculty of Medicine, Department of Psychiatry, Adana, Turkey
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Paris J. Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders. Harv Rev Psychiatry 2004; 12:140-5. [PMID: 15371068 DOI: 10.1080/10673220490472373] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article addresses the question whether borderline personality disorder (BPD) can be understood as a variant of bipolar disorder. In the past, borderline pathology has been seen as a variant of psychosis, depression, or posttraumatic stress disorder, but there are important differences between all of these conditions and BPD. The proposal that BPD falls within the bipolar spectrum depends on the assumption that affective instability develops through the same mechanism in both diagnostic categories. There are major differences in phenomenology, family history, longitudinal course, and treatment response between BPD and bipolar disorder, and the findings of comorbidity studies are equivocal. Thus, existing evidence is insufficient to support the concept that BPD falls in the bipolar spectrum.
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Affiliation(s)
- Joel Paris
- Department of Psychiatry, McGill University, Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Québec, Canada.
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Abstract
In recent years, advances in the areas of both bipolar and borderline personality disorders have generated considerable interest in the clinical interface between these two conditions. Developments in the study of the neurobiology of borderline personality disorder suggest that many patients with this diagnosis have etiological features in common with those diagnosed with bipolar disorders. This claim is supported by new insights into the phenomenology of both disorders and by evidence that mood stabilizers are efficacious in the pharmacological management of borderline patients. This area of research is an important one because of the considerable morbidity and public health costs associated with borderline personality disorder. Since borderline patients can be so challenging to care for, it may be that a reframing of the disorder as belonging to the broad clinical spectrum of bipolar disorders holds benefits for patients and clinicians alike.
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Affiliation(s)
- Daniel J Smith
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland.
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45
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SCHIAVONE PAOLO. COMORBIDITY OF DSM-IV PERSONALITY DISORDERS IN UNIPOLAR AND BIPOLAR AFFECTIVE DISORDERS: A COMPARATIVE STUDY. Psychol Rep 2004. [DOI: 10.2466/pr0.95.5.121-128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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George EL, Miklowitz DJ, Richards JA, Simoneau TL, Taylor DO. The comorbidity of bipolar disorder and axis II personality disorders: prevalence and clinical correlates. Bipolar Disord 2003; 5:115-22. [PMID: 12680901 DOI: 10.1034/j.1399-5618.2003.00028.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Many studies have examined the prevalence and predictive validity of axis II personality disorders among unipolar depressed patients, but few have examined these issues among bipolar patients. The few studies that do exist suggest that axis II pathology complicates the diagnosis and course of bipolar disorder. This study examined the prevalence of axis II disorder in bipolar patients who were clinically remitted. METHODS We assessed the co-occurrence of personality disorder among 52 remitted DSM-III-R bipolar patients using a structured diagnostic interview, the Personality Disorder Examination (PDE). RESULTS Axis II disorders can be rated reliably among bipolar patients who are in remission. Co-diagnosis of personality disorder occurred in 28.8% of patients. Cluster B (dramatic, emotionally erratic) and cluster C (fearful, avoidant) personality disorders were more common than cluster A (odd, eccentric) disorders. Bipolar patients with personality disorders differed from bipolar patients without personality disorders in the severity of their residual mood symptoms, even during remission. CONCLUSIONS When structured assessment of personality disorder is performed during a clinical remission, less than one in three bipolar patients meets full syndromal criteria for an axis II disorder. Examining rates of comorbid personality disorder in broad-based community samples of bipolar spectrum patients would further clarify the linkage between these sets of disorders.
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Affiliation(s)
- Elizabeth L George
- Department of Psychology, University of Colorado, Boulder, CO 80309-0345, USA.
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Vieta E, Colom F, Corbella B, Martínez-Arán A, Reinares M, Benabarre A, Gastó C. Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disord 2002. [PMID: 11903208 DOI: 10.1034/j.1399-5618.2001.30504.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To ascertain the clinical implications of psychiatric comorbidity in the course and outcome of bipolar I patients. METHODS One hundred and twenty-nine bipolar I outpatients in remission [Young Mania Rating Scale (Y-MRS) < 7, Hamilton Depression Rating Scale (HDRS) < 9] were assessed by means of the Structured Clinical Interview for DSM-III-R axis I and axis II (SCID-I and SCID-II) in order to detect all possible psychiatric comorbid diagnoses. The sample was split according to the presence of psychiatric comorbidity and the groups were compared. RESULTS Psychiatric comorbidity was detected in 31% of the sample. A higher number of mixed features, depressive episodes and suicide attempts and a predominance of depressive onset amongst comorbid bipolar patients were the most relevant differences between the two groups. CONCLUSIONS There is an association between depression, suicidality and comorbidity in bipolar I disorder. As comorbidity had a clear relevance in the course and outcome of bipolar illness, this issue should be specifically assessed in clinical practice.
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Affiliation(s)
- E Vieta
- Barcelona Stanley Foundation Research Center, Hospital Clinic, University of Barcelona, Spain.
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