1
|
So SHW, Chau AKC, Chung LKH, Leung CM, Chong GH, Chang WC, Mak AD, Chan SS, Lee S, Sommer IE. Moment-to-moment affective dynamics in schizophrenia and bipolar disorder. Eur Psychiatry 2023; 66:e67. [PMID: 37544924 PMCID: PMC10594258 DOI: 10.1192/j.eurpsy.2023.2438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Affective disturbances in schizophrenia and bipolar disorder may represent a transdiagnostic etiological process as well as a target of intervention. Hypotheses on similarities and differences in various parameters of affective dynamics (intensity, successive/acute changes, variability, and reactivity to stress) between the two disorders were tested. METHODS Experience sampling method was used to assess dynamics of positive and negative affect, 10 times a day over 6 consecutive days. Patients with schizophrenia (n = 46) and patients with bipolar disorder (n = 46) were compared against age-matched healthy controls (n = 46). RESULTS Compared to controls, the schizophrenia group had significantly more intense momentary negative affect, a lower likelihood of acute changes in positive affect, and reduced within-person variability of positive affect. The bipolar disorder group was not significantly different from either the schizophrenia group or the healthy control group on any affect indexes. Within the schizophrenia group, level of depression was associated with weaker reactivity to stress for negative affect. Within the bipolar disorder group, level of depression was associated with lower positive affect. CONCLUSIONS Patients with schizophrenia endured a more stable and negative affective state than healthy individuals, and were less likely to be uplifted in response to happenings in daily life. There is little evidence that these affective constructs characterize the psychopathology of bipolar disorder; such investigation may have been limited by the heterogeneity within group. Our findings supported the clinical importance of assessing multiple facets of affective dynamics beyond the mean levels of intensity.
Collapse
Affiliation(s)
- Suzanne Ho-wai So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Anson Kai Chun Chau
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
- Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Chung-ming Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - George H.C. Chong
- Department of Clinical Psychology, Kwai Chung Hospital, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Arthur D.P. Mak
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Sandra S.M. Chan
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Sing Lee
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Iris E. Sommer
- Department of Psychiatry, University Medical Centre Groningen, The Netherlands
| |
Collapse
|
2
|
Garza Guerra ADJ, Adame Rocha GH, Rodríguez Lara FJ. Clinical differences between bipolar disorder and borderline personality disorder: a case report. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2022; 51:330-334. [PMID: 36443209 DOI: 10.1016/j.rcpeng.2020.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/28/2020] [Indexed: 06/16/2023]
Abstract
The clinical difference between bipolar disorder and borderline personality disorder has always been a diagnostic challenge, especially with type II bipolar disorder and subthreshold symptoms, opening a diagnostic bias with the consequent repercussions of inappropriate treatment. Both pathologies are often misdiagnosed initially. The objective of this article is to emphasise the main clinical differences between the two pathologies. We present the case of a patient with a long history of psychiatric symptoms that started in childhood, with considerable functional impairment, who met the criteria for both disorders, pointing to comorbidity. During follow-up, she responded favourably to psychotropic drugs, pushing the diagnosis towards the bipolar spectrum, due to the notable improvement. However, comorbidity should not be neglected due to its high presentation.
Collapse
Affiliation(s)
- Alfredo de Jesús Garza Guerra
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México.
| | - Gabriela Hilian Adame Rocha
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Francisco Javier Rodríguez Lara
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| |
Collapse
|
3
|
Durdurak BB, Altaweel N, Upthegrove R, Marwaha S. Understanding the development of bipolar disorder and borderline personality disorder in young people: a meta-review of systematic reviews. Psychol Med 2022; 52:1-14. [PMID: 36177878 PMCID: PMC9816307 DOI: 10.1017/s0033291722003002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/31/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is ongoing debate on the nosological position of bipolar disorder (BD) and borderline personality disorder (BPD). Identifying the unique and shared risks, developmental pathways, and symptoms in emerging BD and BPD could help the field refine aetiological hypotheses and improve the prediction of the onset of these disorders. This study aimed to: (a) systematically synthesise the available evidence from systematic reviews (SRs) and meta-analyses (MAs) concerning environmental, psychosocial, biological, and clinical factors leading to the emergence of BD and BPD; (b) identify the main differences and common features between the two disorders to characterise their complex interplay and, (c) highlight remaining evidence gaps. METHODS Data sources were; PubMed, PsychINFO, Embase, Cochrane, CINAHL, Medline, ISI Web of Science. Overlap of included SRs/MAs was assessed using the corrected covered area process. The methodological quality of each included SR and MA was assessed using the AMSTAR. RESULTS 22 SRs and MAs involving 249 prospective studies met eligibility criteria. Results demonstrated that family history of psychopathology, affective instability, attention deficit hyperactivity disorder, anxiety disorders, depression, sleep disturbances, substance abuse, psychotic symptoms, suicidality, childhood adversity and temperament were common predisposing factors across both disorders. There are also distinct factors specific to emerging BD or BPD. CONCLUSIONS Prospective studies are required to increase our understanding of the development of BD and BPD onset and their complex interplay by concurrently examining multiple measures in BD and BPD at-risk populations.
Collapse
Affiliation(s)
- Buse Beril Durdurak
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Nada Altaweel
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Rachel Upthegrove
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Steven Marwaha
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
- Specialist Mood Disorders Clinic, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
4
|
Palmer BA, Pahwa M, Geske JR, Kung S, Nassan M, Schak KM, Alarcon RD, Frye MA, Singh B. Self-report screening instruments differentiate bipolar disorder and borderline personality disorder. Brain Behav 2021; 11:e02201. [PMID: 34056864 PMCID: PMC8323027 DOI: 10.1002/brb3.2201] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/24/2020] [Accepted: 05/10/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) and borderline personality disorder (BPD) share overlapping phenomenology and are frequently misdiagnosed. This study investigated the diagnostic accuracy of the Mood Disorder Questionnaire (MDQ) and McLean Screening Instrument for Borderline Personality Disorder (MSI) in a clinical inpatient setting and whether individual screening items could differentiate BD from BPD. METHODS 757 sequential inpatients admitted to a Mood Disorder Unit completed both the MDQ and MSI. Screen positive for the MDQ was defined as ≥7/13 symptoms endorsed with concurrence and at least moderate impact. Screen positive for the MSI was defined as a score of ≥7. The clinical discharge summary diagnosis completed by a board-certified psychiatrist was used as the reference standard to identify concordance rates of a positive screen with clinical diagnosis. Individual items predicting one disorder and simultaneously predicting absence of other disorder by odds ratio (OR>and <1) were identified. RESULTS Both screening instruments were more specific than sensitive (MDQ 83.7%/ 67.8%, MSI 73.2% / 63.3%). MDQ individual items (elevated mood, grandiosity, increased energy, pressured speech, decreased need for sleep, hyperactivity) were significant predictors of BD diagnosis and non-predictors of BPD diagnosis. Whereas MSI subitem, self-harm behaviors/suicidal attempts predicted BPD in the absence of BD; distrust and irritability were additional predictors of BPD. CONCLUSION While this study is limited by the lack of structured diagnostic interview, these data provide differential symptoms to discriminate BD and BPD. Further work with larger datasets and more rigorous bioinformatics machine learning methodology is encouraged to continue to identify distinguishing features of these two disorders to guide diagnostic precision and subsequent treatment recommendations.
Collapse
Affiliation(s)
- Brian A Palmer
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.,Mental Health and Addiction Clinical Service Line, Allina Health, Minneapolis, MN, USA
| | - Mehak Pahwa
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Jennifer R Geske
- Department of Quantitative Health Services, Mayo Clinic, Rochester, MN, USA
| | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Malik Nassan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Kathryn M Schak
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Renato D Alarcon
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Balwinder Singh
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
5
|
Du M, Zhang L, Li L, Ji E, Han X, Huang G, Liang Z, Shi L, Yang H, Zhang Z. Abnormal transitions of dynamic functional connectivity states in bipolar disorder: A whole-brain resting-state fMRI study. J Affect Disord 2021; 289:7-15. [PMID: 33906006 DOI: 10.1016/j.jad.2021.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Dynamic functional connectivity (dFC) based on resting-state fMRI has attracted interest in the field of bipolar disorder (BD), because dFC can better capture the evolving processes of emotion and cognition, which are typically impaired in BD. However, previous dFC studies of BD have typically focused on specific seed brain regions or specific functional brain networks, and they have ignored global dynamic information interaction in the whole brain. This study is aimed to reveal aberrant and interpretable whole-brain dFC patterns of BD. METHODS The resting-state fMRI data collected from 35 euthymic BD patients and 30 healthy people. We developed a new dFC inference pipeline, including the sliding-window method, k-means clustering, a new permutation with zero-inflated Poisson regression method, and a similarity analysis for interpretable states, to examine the different patterns of dFC states between BD patients and healthy participants. RESULTS BD patients had significantly more frequent transitions between two specific dFC states, which were respectively close to high-level cognitive networks and low-level sensory networks, than healthy controls (p < 0.05, FDR). LIMITATIONS The size of samples and other BD types need to be expanded to validate the results of this study. Possible confounding effect of medication. CONCLUSIONS This study detected aberrant dFC pattern of BD, which indicated the increased lability of the processes of cognition and emotion in BD, and this finding could improve our understanding of the neuropathological mechanism of BD.
Collapse
Affiliation(s)
- Mengjiao Du
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China; Marshall Laboratory of Biomedical Engineering, Shenzhen 518060, China
| | - Li Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China; Marshall Laboratory of Biomedical Engineering, Shenzhen 518060, China
| | - Linling Li
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China; Marshall Laboratory of Biomedical Engineering, Shenzhen 518060, China
| | - Erni Ji
- Department for Bipolar Disorders, Shenzhen Mental Health Centre, Shenzhen Key Lab for Psychological Healthcare, Shenzhen 518020, China
| | - Xue Han
- Department of Mental Health, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen 518060, China
| | - Gan Huang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China; Marshall Laboratory of Biomedical Engineering, Shenzhen 518060, China
| | - Zhen Liang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China; Marshall Laboratory of Biomedical Engineering, Shenzhen 518060, China
| | - Li Shi
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China; Marshall Laboratory of Biomedical Engineering, Shenzhen 518060, China
| | - Haichen Yang
- Department for Bipolar Disorders, Shenzhen Mental Health Centre, Shenzhen Key Lab for Psychological Healthcare, Shenzhen 518020, China.
| | - Zhiguo Zhang
- School of Biomedical Engineering, Health Science Center, Shenzhen University, Shenzhen 518060, China; Guangdong Provincial Key Laboratory of Biomedical Measurements and Ultrasound Imaging, Shenzhen 518060, China; Marshall Laboratory of Biomedical Engineering, Shenzhen 518060, China; Peng Cheng Laboratory, Shenzhen 518055, China.
| |
Collapse
|
6
|
Mesbah R, de Bles N, Rius‐Ottenheim N, van der Does AJW, Penninx BWJH, van Hemert AM, de Leeuw M, Giltay EJ, Koenders M. Anger and cluster B personality traits and the conversion from unipolar depression to bipolar disorder. Depress Anxiety 2021; 38:671-681. [PMID: 33503287 PMCID: PMC8248435 DOI: 10.1002/da.23137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/11/2020] [Accepted: 12/23/2020] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Feelings of anger and irritability are prominent symptoms of bipolar disorder (BD) that may occur during hypomanic, depressive and, especially, during mixed mood states. We aimed to determine whether such constructs are associated with the conversion to BD in subjects with a history of unipolar depression. METHODS Data were derived from the depressed participants of Netherlands Study of Depression and Anxiety with 9 years of follow-up. Hypomania was ascertained using the Composite International Diagnostic Interview at 2, 4, 6, and 9 years follow-up. Cross-sectionally, we studied the association between prevalent hypomania and anger related constructs with the "Spielberger Trait Anger subscale," the "Anger Attacks" questionnaire, the cluster B personality traits part of the "Personality Disorder Questionnaire," and "aggression reactivity." Prospectively, we studied whether aggression reactivity predicted incident hypomania using Cox regression analyses. RESULTS Cross-sectionally, the bipolar conversion group (n = 77) had significantly higher scores of trait anger and aggression reactivity, as well as a higher prevalence on "anger attacks," "antisocial traits," and "borderline traits" compared to current (n = 349) as well as remitted (n = 1159) depressive patients. In prospective analyses in 1744 participants, aggression reactivity predicted incident hypomania (n = 28), with a multivariate-adjusted hazard ratio of 1.4 (95% confidence interval: 1.02-1.93; p = .037). CONCLUSION Anger is a risk factor for conversion from unipolar depression to BD. In addition, patients who converted to BD showed on average more anger, agitation and irritability than people with a history of unipolar depression who had not converted.
Collapse
Affiliation(s)
- Rahele Mesbah
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands,Department of Mood DisordersMental Health Care PsyQ KralingenRotterdamThe Netherlands
| | - Nienke de Bles
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | | | | | - Brenda W. J. H. Penninx
- Department of Psychiatry and Amsterdam NeuroscienceVU University Medical CenterAmsterdamThe Netherlands
| | | | - Max de Leeuw
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands,Mental Health Care RivierduinenBipolar Disorder Outpatient ClinicLeidenThe Netherlands
| | - Erik J. Giltay
- Department of PsychiatryLeiden University Medical CenterLeidenThe Netherlands
| | - Manja Koenders
- Department of Mood DisordersMental Health Care PsyQ KralingenRotterdamThe Netherlands,Department of Clinical PsychologyLeiden UniversityLeidenThe Netherlands
| |
Collapse
|
7
|
Bayes A, Spoelma MJ, Hadzi-Pavlovic D, Parker G. Differentiation of bipolar disorder versus borderline personality disorder: A machine learning approach. J Affect Disord 2021; 288:68-73. [PMID: 33845326 DOI: 10.1016/j.jad.2021.03.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Differentiation of bipolar disorder (BP) from borderline personality disorder (BPD) is a common diagnostic dilemma. We undertook a machine learning (ML) approach to distinguish the conditions. METHODS Participants meeting DSM criteria for BP or BPD were compared on measures examining cognitive and behavioral BPD constructs, emotion regulation strategies, and parental behaviors during childhood. Two analyses used continuous and dichotomised data, with ML-allocated diagnoses compared to DSM. RESULTS 82 participants met DSM criteria for BP and 52 for BPD. Accuracy of ML classification was 84.1% - 87.8% for BP, 50% - 57.7% for BPD, with overall accuracy of 73.1% - 73.9%. Importance of items differed between the analyses with the overall most important items including identity difficulties, relationship problems, female gender, feeling suicidal after a relationship breakdown and age. LIMITATIONS Participants were volunteers, preponderance of bipolar II (BP II) participants, comorbidity of BP and BPD not examined, and small BPD sample contributed to the relatively low classification accuracies for this group CONCLUSIONS: Study findings may assist distinguishing BP and BPD based on differences in cognitive and behavioral domains, emotion regulation strategies and parental behaviors. Future studies using larger datasets could further improve predictive accuracy and assist in differential diagnosis.
Collapse
Affiliation(s)
- Adam Bayes
- Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Australia.
| | | | | | - Gordon Parker
- School of Psychiatry, University of New South Wales, NSW, Australia
| |
Collapse
|
8
|
Garza Guerra ADJ, Adame Rocha GH, Rodríguez Lara FJ. Clinical Differences between Bipolar Disorder and Borderline Personality Disorder: A Case Report. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2021; 51:S0034-7450(21)00029-9. [PMID: 33734997 DOI: 10.1016/j.rcp.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/14/2020] [Accepted: 12/28/2020] [Indexed: 06/12/2023]
Abstract
The clinical difference between bipolar disorder and borderline personality disorder has always been a diagnostic challenge, especially with type II bipolar disorder and subthreshold symptoms, opening a diagnostic bias with the consequent repercussions of inappropriate treatment. Both pathologies are often misdiagnosed initially. The objective of this article is to emphasise the main clinical differences between the two pathologies. We present the case of a patient with a long history of psychiatric symptoms that started in childhood, with considerable functional impairment, who met the criteria for both disorders, pointing to comorbidity. During follow-up, she responded favourably to psychotropic drugs, pushing the diagnosis towards the bipolar spectrum, due to the notable improvement. However, comorbidity should not be neglected due to its high presentation.
Collapse
Affiliation(s)
- Alfredo de Jesús Garza Guerra
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México.
| | - Gabriela Hilian Adame Rocha
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Francisco Javier Rodríguez Lara
- Departamento de Psiquiatría, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, México
| |
Collapse
|
9
|
Affective and non-affective cognition in patients with bipolar disorder type I and type II in full or partial remission: Associations with familial risk. J Affect Disord 2021; 283:207-215. [PMID: 33561801 DOI: 10.1016/j.jad.2021.01.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 01/09/2021] [Accepted: 01/30/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The upcoming conversion of the ICD-11 will subdivide patients with bipolar disorder (BD) into BD type I (BD-I) and BD type II (BD-II). This study aimed to investigate whether cognitive impairments could aid as objective cognitive biomarkers for recently diagnosed BD subtypes by comparing cognitive profiles between BD subtypes, their unaffected relatives (UR), and healthy controls (HC). METHODS The sample included 76 patients with BD-I, 149 patients with BD-II, 28 UR of patients with BD-I (UR-I), 50 UR of patients with BD-II (UR-II) and 168 HC from the Bipolar Illness Onset study, who were assessed with an extensive non-affective and affective cognitive test battery. RESULTS The results showed no significant differences in affective or non-affective cognition between BD-I and BD-II. Compared to HC, patients with BD-I (but not BD-II) showed worse performance in verbal fluency (p = .01) and were slower at recognising fearful faces (p = .045), while patients with BD-II (but not BD-I) displayed generally poorer recognition of facial expressions (p = .02). Only UR-I showed lower performance on verbal fluency (p = .049) and aberrant affective cognition (ps≤.047) compared to HC. LIMITATIONS The potential confounding effects of medication were not explored. CONCLUSIONS The lack of significant differences in cognitive profiles between recently diagnosed BD-I and BD-II suggests that neither affective nor non-affective cognition are indicative of BD subtype.
Collapse
|
10
|
Bøen E, Hummelen B, Boye B, Elvsåshagen T, Malt UF. Borderline patients have difficulties describing feelings; bipolar II patients describe difficult feelings. An alexithymia study. Acta Psychiatr Scand 2020; 142:203-214. [PMID: 32594515 DOI: 10.1111/acps.13204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Apparent similarities between borderline personality disorder (BPD) and bipolar II disorder (BIP-II) contribute to clinical difficulties in distinguishing between the disorders. Here, we aimed to explore how subjective Difficulties with the Identification and Description of Feelings (DIDF), a major constituent of the alexithymia construct and assessed as a part of the Toronto Alexithymia Scale (TAS), are related to relationship problems and health complaints in these groups. METHODS Twenty-two patients with BPD; 22 patients with BIP-II; and 23 healthy controls (HC) completed TAS. Health complaints, including symptoms associated with mood swings, were assessed with the Giessener Subjective Complaints List (Giessener Beschwerdebogen-GBB), and relationship problems with the Health of the Nation Outcome scale, Relationship item (HoNOSR). Bivariate correlations were run. RESULTS Both patient groups had high DIDF and GBB scores. In BPD only, there was a significant positive correlation between DIDF and HoNOSR. In BIP-II only, there was a significant positive correlation between DIDF and GBB total score. In BIP-II, DIDF correlated highly with those GBB subscales assessing symptoms typically occurring during bipolar mood swings (cardiovascular and gastrointestinal symptoms, exhaustion). CONCLUSION Our results suggest that in BPD, high DIDF scores represent genuine problems with identifying and describing emotions which are expected to correlate with relationship problems. In BIP-II, high DIDF scores could potentially represent difficulties with understanding the unpredictable symptoms of bipolar mood swings. The findings suggest that difficulties with identifying and describing feelings in patients should be carefully explored to increase the validity of the diagnostic evaluation.
Collapse
Affiliation(s)
- E Bøen
- Psychosomatic and CL Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - B Hummelen
- Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - B Boye
- Psychosomatic and CL Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Behavioural Medicine, University of Oslo, Oslo, Norway
| | - T Elvsåshagen
- Norwegian Centre for Mental Disorders Research (NORMENT), KG Jebsen Centre for Psychosis Research, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - U F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
11
|
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: 18] [Impact Index Per Article: 3.6] [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.
Collapse
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
| |
Collapse
|
12
|
Cognitive and Behavioral Differentiation of Those With Borderline Personality Disorder and Bipolar Disorder. J Nerv Ment Dis 2019; 207:620-625. [PMID: 31283725 DOI: 10.1097/nmd.0000000000001024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The current study sought to identify features offering differentiation of borderline personality disorder (BPD) from bipolar disorder (BP). Participants were clinically assessed and assigned diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders criteria. A 113-item self-report questionnaire was completed, comprising cognitive and behavioral constructs weighted to a borderline personality style. A total of n = 53 participants were assigned to BPD, n = 83 to BP, with comorbid participants excluded. Twenty items were highly endorsed (>95%) by the BPD group, with most of the features capturing emotional dysregulation (ED) and identity disturbance; however, many items were also highly endorsed by the participants with BP. Thirty-eight items offered differentiation of BPD from BP, with identity disturbance overrepresented. The study findings indicate that the transdiagnostic nature of ED (a feature of both conditions) means it is less useful for diagnostic decisions, whereas identity disturbance is both intrinsic to BPD and offers specificity in differentiation from BP.
Collapse
|
13
|
Yu H, Meng YJ, Li XJ, Zhang C, Liang S, Li ML, Li Z, Guo W, Wang Q, Deng W, Ma X, Coid J, Li T. Common and distinct patterns of grey matter alterations in borderline personality disorder and bipolar disorder: voxel-based meta-analysis. Br J Psychiatry 2019; 215:395-403. [PMID: 30846010 DOI: 10.1192/bjp.2019.44] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Whether borderline personality disorder (BPD) and bipolar disorder are the same or different disorders lacks consistency.AimsTo detect whether grey matter volume (GMV) and grey matter density (GMD) alterations show any similarities or differences between BPD and bipolar disorder. METHOD Web-based publication databases were searched to conduct a meta-analysis of all voxel-based studies that compared BPD or bipolar disorder with healthy controls. We included 13 BPD studies (395 patients with BPD and 415 healthy controls) and 47 bipolar disorder studies (2111 patients with bipolar disorder and 3261 healthy controls). Peak coordinates from clusters with significant group differences were extracted. Effect-size signed differential mapping meta-analysis was performed to analyse peak coordinates of clusters and thresholds (P < 0.005, uncorrected). Conjunction analyses identified regions in which disorders showed common patterns of volumetric alteration. Correlation analyses were also performed. RESULTS Patients with BPD showed decreased GMV and GMD in the bilateral medial prefrontal cortex network (mPFC), bilateral amygdala and right parahippocampal gyrus; patients with bipolar disorder showed decreased GMV and GMD in the bilateral medial orbital frontal cortex (mOFC), right insula and right thalamus, and increased GMV and GMD in the right putamen. Multi-modal analysis indicated smaller volumes in both disorders in clusters in the right medial orbital frontal cortex. Decreased bilateral mPFC in BPD was partly mediated by patient age. Increased GMV and GMD of the right putamen was positively correlated with Young Mania Rating Scale scores in bipolar disorder. CONCLUSIONS Our results show different patterns of GMV and GMD alteration and do not support the hypothesis that bipolar disorder and BPD are on the same affective spectrum.Declaration of interestNone.
Collapse
Affiliation(s)
- Hua Yu
- Associate Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Ya-Jing Meng
- Associate Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Xiao-Jing Li
- Associate Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Chengcheng Zhang
- Associate Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Sugai Liang
- Associate Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Ming-Li Li
- Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Zhe Li
- Lecturer,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Wanjun Guo
- Lecturer,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Qiang Wang
- Lecturer,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Wei Deng
- Lecturer,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Xiaohong Ma
- Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Jeremy Coid
- Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| | - Tao Li
- Researcher,Mental Health Center,West China Hospital of Sichuan University;Psychiatric Laboratory,State Key Laboratory of Biotherapy,West China Hospital of Sichuan University;and Brain Research Center,West China Hospital of Sichuan University,China
| |
Collapse
|
14
|
Mazer AK, Cleare AJ, Young AH, Juruena MF. Bipolar affective disorder and borderline personality disorder: Differentiation based on the history of early life stress and psychoneuroendocrine measures. Behav Brain Res 2019; 357-358:48-56. [PMID: 29702176 DOI: 10.1016/j.bbr.2018.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/30/2018] [Accepted: 04/11/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Borderline Personality Disorder (BPD) and Bipolar Affective Disorder (BD) have clinical characteristics in common which often make their differential diagnosis difficult. The history of early life stress (ELS) may be a differentiating factor between BPD and BD, as well as its association with clinical manifestations and specific neuroendocrine responses in each of these diagnoses. OBJECTIVE Assessing and comparing patients with BD and BPD for factors related to symptomatology, etiopathogenesis and neuroendocrine markers. METHODOLOGY The study sample consisted of 51 women, divided into 3 groups: patients with a clinical diagnosis of BPD (n = 20) and BD (n = 16) and healthy controls (HC, n = 15). Standardized instruments were used for the clinical evaluation, while the history of ELS was quantified with the Childhood Trauma Questionnaire (CTQ), and classified according to the subtypes: emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. The functioning of the hypothalamic-pituitary-adrenal (HPA) axis was evaluated by measuring a single plasma cortisol sample. RESULTS Patients with BPD presented with more severe psychiatric symptoms of: anxiety, impulsivity, depression, hopelessness and suicidal ideation than those with BD. The history of ELS was identified as significantly more prevalent and more severe in patients (BPD and BP) than in HC. Emotional abuse, emotional neglect and physical neglect also showed differences and were higher in BPD than BD patients. BPD patients had greater severity of ELS overall and in the subtypes of emotional abuse, emotional neglect and physical neglect than BD patients. The presence of ELS in patients with BPD and BP showed significant difference with lower cortisol levels when compared to HC. The endocrine evaluation showed no significant differences between the diagnoses of BPD and BD. Cortisol measured in patients with BPD was significantly lower compared to HC in the presence of emotional neglect and physical neglect. A significant negative correlation between the severity of hopelessness vs cortisol; and physical neglect vs cortisol were found in BPD with ELS. The single cortisol sample showed a significant and opposite correlations in the sexual abuse diagnosis-related groups, being a negative correlation in BD and positive in BPD. DISCUSSION Considering the need for a multi-factorial analysis, the differential diagnosis between BPD and BD can be facilitated by the study of psychiatric symptoms, which are more severe in the BPD patients with a history of early life stress. The function of the HPA axis assessed by this cortisol measure suggests differences between BPD and BP with ELS history. CONCLUSION The integrated analysis of psychopathology, ELS and neuroendocrine function may provide useful indicators to differentiate BPD and BD diagnoses. These preliminary data need to be replicated in a more significant sample with improved and multiple assessments of HPA axis activity.
Collapse
Affiliation(s)
| | - Anthony J Cleare
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience & South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Allan H Young
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience & South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Mario F Juruena
- Department of Neuroscience and Behavior, University of Sao Paulo, Brazil; King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience & South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK.
| |
Collapse
|
15
|
Asenapine in the management of impulsivity and aggressiveness in bipolar disorder and comorbid borderline personality disorder: an open-label uncontrolled study. Int Clin Psychopharmacol 2018; 33:121-130. [PMID: 29189421 PMCID: PMC5895133 DOI: 10.1097/yic.0000000000000206] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Borderline personality disorder (BPD) often co-occurres with bipolar disorder (BD). Impulsivity and aggressiveness represent core shared features and their pharmacological management is mainly based on mood stabilizers and antipsychotics, although scarce evidence is available for this context of comorbidity. The aim of the present study was to evaluate the role of Asenapine as an adjunctive drug for reducing aggressiveness and impulsivity in a sample of Italian BD type I outpatients with or without a comorbid BPD. This was an observational 12-week open-label uncontrolled clinical study carried out from April to October 2014 in two psychiatric clinics in Sicily. Each patient was treated with asenapine at two dose options, 5 mg (twice daily) or 10 mg (twice daily), and concomitant ongoing medications were not discontinued. We measured impulsivity using the Barratt Impulsiveness Scale (BIS) and aggressiveness using the Aggressive Questionnaire (AQ). For the analysis of our outcomes, patients were divided into two groups: with or without comorbid BPD. Adjunctive therapy was associated with a significant decrease of BIS and AQ overall scores in the entire bipolar sample. Yet, there was no significant difference in BIS and AQ reductions between subgroups. Using a regression model, we observed that concomitant BPD played a negative role on the Hostility subscale and overall AQ score variations; otherwise, borderline co-diagnosis was related positively to the reduction of physical aggression. According to our post-hoc analysis, global aggressiveness scores are less prone to decrease in patients with a dual diagnosis, whereas physical aggressiveness appears to be more responsive to the add-on therapy in patients with comorbidity.
Collapse
|
16
|
Leblanc A, Jarroir M, Vorspan F, Bellivier F, Leveillee S, Romo L. Dimensions affectives et impulsives dans le trouble bipolaire et le trouble de la personnalité borderline. Encephale 2017; 43:199-204. [DOI: 10.1016/j.encep.2016.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 05/04/2015] [Indexed: 01/02/2023]
|
17
|
Differences in clinical presentation between bipolar I and II disorders in the early stages of bipolar disorder: A naturalistic study. J Affect Disord 2017; 208:521-527. [PMID: 27816324 DOI: 10.1016/j.jad.2016.10.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/30/2016] [Accepted: 10/22/2016] [Indexed: 11/23/2022]
Abstract
AIM In a naturalistic clinical study of patients in the early stages of bipolar disorders the aim was to assess differences between patients with bipolar I (BD I) and bipolar II (BD II) disorders on clinical characteristics including affective symptoms, subjective cognitive complaints, functional level, the presence of comorbid personality disorders and coping strategies. METHODS Diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Disorders. Clinical symptoms were rated with the Young Mania Rating Scale and the Hamilton Depression Rating Scale, and functional status using the Functional Assessment Short Test. Cognitive complaints were assessed using the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire, the presence of comorbid personality disorders using the Standardized Assessment of Personality - Abbreviated Scale and coping style using the Coping Inventory for Stressful Situations. RESULTS In total, 344 patients were included (BD I (n=163) and BD II (n=181). Patients with BD II presented with significantly more depressive symptoms, more cognitive complaints, lower overall functioning, and a higher prevalence of comorbid personality disorders. Finally, they exhibited a trend towards using less adaptive coping styles. LIMITATION It cannot be omitted that some patients may have progressed from BD II to BD I. Most measures were based on patient self report. CONCLUSIONS Overall, BD II was associated with a higher disease burden. Clinically, it is important to differentiate BD II from BD I and research wise, there is a need for tailoring and testing specific interventions towards BD II.
Collapse
|
18
|
Trunko ME, Schwartz TA, Berner LA, Cusack A, Nakamura T, Bailer UF, Chen JY, Kaye WH. A pilot open series of lamotrigine in DBT-treated eating disorders characterized by significant affective dysregulation and poor impulse control. Borderline Personal Disord Emot Dysregul 2017; 4:21. [PMID: 29043085 PMCID: PMC5632524 DOI: 10.1186/s40479-017-0072-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 09/25/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is little effective psychopharmacological treatment for individuals with eating disorders who struggle with pervasive, severe affective and behavioral dysregulation. METHODS This pilot open series evaluated lamotrigine, a mood stabilizer, in the treatment of patients with eating disorders who did not respond adequately to antidepressant medications. Nine women with anorexia nervosa- or bulimia nervosa-spectrum eating disorders in partial hospital or intensive outpatient dialectical behavior therapy (DBT)-based eating disorder treatment took lamotrigine for 147 ± 79 days (mean final dose = 161.1 ± 48.6 mg/day). Participants completed standardized self-report measures of emotion dysregulation and impulsivity after lamotrigine initiation and approximately biweekly thereafter. Mood and eating disorder symptomatology were measured at lamotrigine initiation and at time of final assessment. RESULTS Lamotrigine and concurrent DBT were associated with large reductions in self-reported affective and behavioral dysregulation (ps < 0.01). Eating disorder and mood symptoms decreased moderately. CONCLUSIONS Although our findings are limited by the confounds inherent in an open series, lamotrigine showed initial promise in reducing emotional instability and behavioral impulsivity in severely dysregulated eating-disordered patients. These preliminary results support further investigation of lamotrigine for eating disorders in rigorous controlled trials.
Collapse
Affiliation(s)
- Mary Ellen Trunko
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Terry A Schwartz
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Laura A Berner
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Anne Cusack
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Tiffany Nakamura
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ursula F Bailer
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,Department of Psychiatry and Psychotherapy, Division of Biological Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Joanna Y Chen
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA.,UCSD Eating Disorder Research and Treatment Program, UCSD Department of Psychiatry, 4510 Executive Dr., Suite 315, San Diego, CA 92121-3021 USA
| |
Collapse
|
19
|
Bayes A, Parker G, McClure G. Emotional dysregulation in those with bipolar disorder, borderline personality disorder and their comorbid expression. J Affect Disord 2016; 204:103-11. [PMID: 27344618 DOI: 10.1016/j.jad.2016.06.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/06/2016] [Accepted: 06/11/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Differentiation of the bipolar disorders (BP) from a borderline personality disorder (BPD) can be challenging owing to shared features, with emotional dysregulation being the likely principal one. AIM To assess differences in emotion regulation strategies in those with BP alone, BPD alone and those comorbid for both. METHODS We interviewed participants previously receiving a BP or BPD diagnosis, studying those who met DSM criteria for one or both conditions. RESULTS The sample comprised 83 with bipolar disorder, 53 with BPD and 54 comorbid for both. Analyses established linear trends, with the greatest impairment in emotion regulation strategies in the comorbid group followed by the BPD group, and with the lowest in the BP group. Specific deficits in the comorbid group included impulsivity, difficulties with goal directed behaviour, and accessing strategies. A similar linear profile was quantified for maladaptive cognitive emotion regulation strategies, weighted to catastrophizing and rumination. Adaptive emotion regulation strategies were superior in the bipolar group, without significant differences observed between the comorbid and BPD groups. LIMITATIONS Reliance on self-report measures; combined BP I and II participants limits generalisability of results to each bipolar sub-type; use of DSM diagnoses risking artefactual comorbidity; while there was an over-representation of females in all groups. CONCLUSIONS Differences in emotion regulation strategies advance differentiation of those with either BP or BPD, while we identify the specificity of differing strategies to each condition and their synergic effect in those comorbid for both conditions. Study findings should assist the development and application of targeted strategies for those with either or both conditions.
Collapse
Affiliation(s)
- Adam Bayes
- School of Psychiatry, University of New South Wales, NSW, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Australia
| | - Georgia McClure
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Australia
| |
Collapse
|
20
|
Frías Á, Baltasar I, Birmaher B. Comorbidity between bipolar disorder and borderline personality disorder: Prevalence, explanatory theories, and clinical impact. J Affect Disord 2016; 202:210-9. [PMID: 27267293 DOI: 10.1016/j.jad.2016.05.048] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 05/21/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The relationship between bipolar disorder (BD) and borderline personality disorder (BPD) has been controversial and widely debated. Specifically, the comorbidity between both disorders has yielded a plethora of research, but there are no comprehensive reviews on this issue. OBJECTIVE To determine the empirical evidence regarding the comorbidity between BD and BPD based on prevalence data, explanatory theories for their co-occurrence, and clinical impact of one disorder in the other. METHOD A comprehensive search of databases (PubMed and PsycINFO) was performed. Published manuscripts between January 1985 and August 2015 were identified. Overall, 70 studies fulfilled inclusion criteria. RESULTS Over a fifth of subjects showed comorbidity between BPD and BD. Empirical evidence from common underlying factors was inconclusive, but BPD appears to be a risk factor for BD. Data also indicated that the negative impact of BPD in BD (e.g., suicidality, worse mood course) was greater than vice verse. CONCLUSIONS Given the high prevalence of comorbidity between BD and BPD and the negative effects of BPD in subjects with BD, further studies are needed to clarify the factor associated with the comorbidity between these two disorders. This information is important to develop appropriate treatments for subjects with both disorders, improve their clinical course, and prevent the increased risk of suicidality commonly found in these subjects.
Collapse
Affiliation(s)
- Álvaro Frías
- FPCEE Blanquerna, University of Ramon-Llull, Barcelona, Spain; Adult Outpatient Mental Health Center, Consorci Sanitari del Maresme, Mataró, Spain; Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, United States.
| | - Itziar Baltasar
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, United States
| | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, United States
| |
Collapse
|
21
|
Abstract
Borderline personality disorder (BPD) has been demonstrated to be a reliable and valid construct in young people (adolescents and young adults). Both borderline- and mood-related psychopathology become clinically apparent from puberty through to young adulthood, frequently co-occur, can reinforce one another, and can be difficult to differentiate clinically. This Gordian knot of overlapping clinical features, common risk factors, and precursors to both BPD and mood disorders complicates clinical assessment, prevention, and treatment. Regardless of whether an individual crosses an arbitrary diagnostic threshold, a considerable proportion of young people with borderline- and mood-related psychopathology will develop significant and persistent functional, vocational, and interpersonal impairment and disability during this critical risk and developmental period. There is a clear need for early intervention, but spurious diagnostic certainty risks stigma, misapplication of diagnostic labels, inappropriate treatment, and unfavorable outcomes. This article aims to integrate early intervention for BPD and mood disorders in the clinical context of developmental and phenomenological change and evolution. "Clinical staging," similar to disease staging in general medicine, is presented as a pragmatic, heuristic, and trans-diagnostic framework to guide prevention and intervention. It acknowledges that the early stages of these disorders cannot be disentangled sufficiently to allow for disorder-specific preventive measures and early interventions. Clinical staging defines an individual's location along the continuum of the evolving temporal course of a disorder. Such staging aids differentiation of early or milder clinical phenomena from those that accompany illness progression and chronicity, and suggests the application of appropriate and proportionate intervention strategies.
Collapse
|
22
|
Bayes AJ, McClure G, Fletcher K, Román Ruiz Del Moral YE, Hadzi-Pavlovic D, Stevenson JL, Manicavasagar VL, Parker GB. Differentiating the bipolar disorders from borderline personality disorder. Acta Psychiatr Scand 2016; 133:187-95. [PMID: 26432099 DOI: 10.1111/acps.12509] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify features differentiating bipolar disorder (BP) from borderline personality disorder (BPD) and with each condition variably defined. METHOD Participants were assigned a BP or BPD diagnosis on the basis of DSM criteria and, separately, by clinical judgment, and undertook a diagnostic interview and completed self-report measures. RESULTS Predictors of BPD status varied according to diagnostic decisions, but with the most consistent items being childhood sexual abuse, childhood depersonalization, personality variables relating to relationship difficulties and sensitivity to criticism, and the absence of any BP family history. Across diagnostic groups, personality measure items alone predicted diagnostic allocation with an accuracy of 81-84%, the refined study variables other than hypo/manic features improved the classification rates to 88%, and when the presence or absence of hypo/manic features was added, classification rates increased to 92-95%. CONCLUSION Study findings indicate that BPD can be differentiated from BP with a high degree of accuracy.
Collapse
Affiliation(s)
- A J Bayes
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
| | - G McClure
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
| | - K Fletcher
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
| | | | - D Hadzi-Pavlovic
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
| | | | | | - G B Parker
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia.,The Black Dog Institute, Sydney, NSW, Australia
| |
Collapse
|
23
|
Malhi GS, Bassett D, Boyce P, Bryant R, Fitzgerald PB, Fritz K, Hopwood M, Lyndon B, Mulder R, Murray G, Porter R, Singh AB. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry 2015; 49:1087-206. [PMID: 26643054 DOI: 10.1177/0004867415617657] [Citation(s) in RCA: 511] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide guidance for the management of mood disorders, based on scientific evidence supplemented by expert clinical consensus and formulate recommendations to maximise clinical salience and utility. METHODS Articles and information sourced from search engines including PubMed and EMBASE, MEDLINE, PsycINFO and Google Scholar were supplemented by literature known to the mood disorders committee (MDC) (e.g., books, book chapters and government reports) and from published depression and bipolar disorder guidelines. Information was reviewed and discussed by members of the MDC and findings were then formulated into consensus-based recommendations and clinical guidance. The guidelines were subjected to rigorous successive consultation and external review involving: expert and clinical advisors, the public, key stakeholders, professional bodies and specialist groups with interest in mood disorders. RESULTS The Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders (Mood Disorders CPG) provide up-to-date guidance and advice regarding the management of mood disorders that is informed by evidence and clinical experience. The Mood Disorders CPG is intended for clinical use by psychiatrists, psychologists, physicians and others with an interest in mental health care. CONCLUSIONS The Mood Disorder CPG is the first Clinical Practice Guideline to address both depressive and bipolar disorders. It provides up-to-date recommendations and guidance within an evidence-based framework, supplemented by expert clinical consensus. MOOD DISORDERS COMMITTEE Professor Gin Malhi (Chair), Professor Darryl Bassett, Professor Philip Boyce, Professor Richard Bryant, Professor Paul Fitzgerald, Dr Kristina Fritz, Professor Malcolm Hopwood, Dr Bill Lyndon, Professor Roger Mulder, Professor Greg Murray, Professor Richard Porter and Associate Professor Ajeet Singh. INTERNATIONAL EXPERT ADVISORS Professor Carlo Altamura, Dr Francesco Colom, Professor Mark George, Professor Guy Goodwin, Professor Roger McIntyre, Dr Roger Ng, Professor John O'Brien, Professor Harold Sackeim, Professor Jan Scott, Dr Nobuhiro Sugiyama, Professor Eduard Vieta, Professor Lakshmi Yatham. AUSTRALIAN AND NEW ZEALAND EXPERT ADVISORS Professor Marie-Paule Austin, Professor Michael Berk, Dr Yulisha Byrow, Professor Helen Christensen, Dr Nick De Felice, A/Professor Seetal Dodd, A/Professor Megan Galbally, Dr Josh Geffen, Professor Philip Hazell, A/Professor David Horgan, A/Professor Felice Jacka, Professor Gordon Johnson, Professor Anthony Jorm, Dr Jon-Paul Khoo, Professor Jayashri Kulkarni, Dr Cameron Lacey, Dr Noeline Latt, Professor Florence Levy, A/Professor Andrew Lewis, Professor Colleen Loo, Dr Thomas Mayze, Dr Linton Meagher, Professor Philip Mitchell, Professor Daniel O'Connor, Dr Nick O'Connor, Dr Tim Outhred, Dr Mark Rowe, Dr Narelle Shadbolt, Dr Martien Snellen, Professor John Tiller, Dr Bill Watkins, Dr Raymond Wu.
Collapse
Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Kolling Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Darryl Bassett
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia School of Medicine, University of Notre Dame, Perth, WA, Australia
| | - Philip Boyce
- Discipline of Psychiatry, Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Paul B Fitzgerald
- Monash Alfred Psychiatry Research Centre (MAPrc), Monash University Central Clinical School and The Alfred, Melbourne, VIC, Australia
| | - Kristina Fritz
- CADE Clinic, Discipline of Psychiatry, Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Bill Lyndon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia ECT Services Northside Group Hospitals, Greenwich, NSW, Australia
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Greg Murray
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Richard Porter
- Department of Psychological Medicine, University of Otago-Christchurch, Christchurch, New Zealand
| | - Ajeet B Singh
- School of Medicine, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
24
|
Abstract
Borderline personality disorder (BPD) is a common and severe mental disorder that is associated with severe functional impairment and a high suicide rate. BPD is usually associated with other psychiatric and personality disorders, high burden on families and carers, continuing resource utilization, and high treatment costs. BPD has been a controversial diagnosis in adolescents, but this is no longer justified. Recent evidence demonstrates that BPD is as reliable and valid among adolescents as it is in adults and that adolescents with BPD can benefit from early intervention. Consequently, adolescent BPD is now recognized in psychiatric classification systems and in national treatment guidelines. This review aims to inform practitioners in the field of adolescent health about the nature of BPD in adolescence and the benefits of early detection and intervention. BPD diagnosis and treatment should be considered part of routine practice in adolescent mental health to improve these individuals' well-being and long-term prognosis.
Collapse
Affiliation(s)
- Michael Kaess
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany;
| | - Romuald Brunner
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Andrew Chanen
- Orygen Youth Health Research Centre & Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; and Orygen Youth Health Clinical Program, Northwestern Mental Health, Melbourne, Australia
| |
Collapse
|
25
|
Riemann G, Weisscher N, Goossens PJJ, Draijer N, Apenhorst-Hol M, Kupka RW. The addition of STEPPS in the treatment of patients with bipolar disorder and comorbid borderline personality features: a protocol for a randomized controlled trial. BMC Psychiatry 2014; 14:172. [PMID: 24912456 PMCID: PMC4065586 DOI: 10.1186/1471-244x-14-172] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 05/27/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Bipolar disorder (BD) and borderline personality disorder (BPD) both are severe and chronic psychiatric disorders. Both disorders have overlapping symptoms, and current research shows that the presence of a BPD has an adverse effect on the course of BD. The limited research available shows an unfavorable illness course, a worse prognosis and response to medication, longer treatment duration, more frequent psychiatric admissions, higher drop-out, increased risk of substance abuse, increased risk of suicide, and more impairment of social and occupational functioning. However, there is no research available on the effect of specific psychotherapeutic treatment for this patients. METHODS/DESIGN This paper presents the protocol of a RCT to investigate the presence of borderline personality features in patients treated for BD (study part 1) and the effectiveness of STEPPS (Systems Training for Emotional Predictability and Problem Solving) added to treatment as usual (TAU) for BD compared to TAU in patients with BD and comorbid borderline personality features (study part 2). STEPPS is a validated and effective intervention for BPD. The study population consists of patients treated for BD at specialized outpatient clinics for BD in the Netherlands. At first the prevalence of comorbid borderline personality features in outpatients with BD is investigated. Inclusion criteria for study part 2 is defined as having three or more of the DSM-IV-TR diagnostic criteria of BPD, including impulsivity and anger bursts. Primary outcomes will be the frequency and severity of manic and depressive recurrences as well as severity, course and burden of borderline personality features. Secondary outcomes will be quality of life, utilizing mental healthcare and psychopathologic symptoms not primarily related to BD or BPD. Assessment will be at baseline, at the end of the intervention, and at 12 and 18 months follow-up. DISCUSSION This will be the first randomized controlled trial of a specific intervention in patients with BD and comorbid BPD or borderline personality features. There are no recommendations in the guideline of treatment of bipolar disorders for patients with this complex comorbidity. We expect that a combined treatment aimed at mood disorder and emotion regulation will improve treatment outcomes for these patients.
Collapse
Affiliation(s)
- Georg Riemann
- Saxion University of Applied Science, Deventer, The Netherlands.
| | - Nadine Weisscher
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, The Netherlands,GGZ Centraal, Center for Mental Health, Hilversum, The Netherlands
| | - Peter JJ Goossens
- Saxion University of Applied Science, Deventer, The Netherlands,Dimence Mental Health, Center for Bipolar Disorders, Deventer, The Netherlands,IQ Healthcare, Scientific Institute for Quality of healthcare, Nijmegen, The Netherlands
| | - Nel Draijer
- GGZ inGeest, Center for Mental Health, Amsterdam, The Netherlands,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Ralph W Kupka
- GGZ inGeest, Center for Mental Health, Amsterdam, The Netherlands,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
26
|
Fletcher K, Parker G, Bayes A, Paterson A, McClure G. Emotion regulation strategies in bipolar II disorder and borderline personality disorder: differences and relationships with perceived parental style. J Affect Disord 2014; 157:52-9. [PMID: 24581828 DOI: 10.1016/j.jad.2014.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Bipolar II disorder (BP II) and Borderline Personality Disorder (BPD) share common features and can be difficult to differentiate, contributing to misdiagnosis and inappropriate treatment. Research contrasting phenomenological features of both conditions is limited. The current study sought to identify differences in emotion regulation strategies in BP II and BPD in addition to examining relationships with perceived parental style. METHOD Participants were recruited from a variety of outpatient and community settings. Eligible participants required a clinical diagnosis of BP II or BPD, subsequently confirmed via structured diagnostic interviews assessing DSM-IV criteria. Participants completed a series of self-reported questionnaires assessing emotion regulation strategies and perceived parental style. RESULTS The sample comprised 48 (n=24 BP II and n=24 BPD) age and gender-matched participants. Those with BPD were significantly more likely to use maladaptive emotion regulation strategies, less likely to use adaptive emotion regulation strategies, and scored significantly higher on the majority of (perceived) dysfunctional parenting sub-scales than participants with BP II. Dysfunctional parenting experiences were related to maladaptive emotion regulation strategies in participants with BP II and BPD, however differential associations were observed across groups. LIMITATIONS Relatively small sample sizes; lack of a healthy control comparator group; lack of statistical control for differing sociodemographic and clinical characteristics, medication and psychological treatments; no assessment of state or trait anxiety; over-representation of females in both groups limiting generalisability of results; and reliance on self-report measures. CONCLUSIONS Differences in emotion regulation strategies and perceived parental style provide some support for the validity of distinguishing BP II and BPD. Development of intervention strategies targeting the differing forms of emotion regulatory pathology in these groups may be warranted.
Collapse
Affiliation(s)
- Kathryn Fletcher
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia.
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Adam Bayes
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Amelia Paterson
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| | - Georgia McClure
- School of Psychiatry, University of New South Wales, NSW, Australia; Black Dog Institute, Hospital Road, Randwick, NSW 2031, Australia
| |
Collapse
|
27
|
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.
Collapse
|
28
|
Nagata T, Yamada H, Teo AR, Yoshimura C, Kodama Y, van Vliet I. Using the mood disorder questionnaire and bipolar spectrum diagnostic scale to detect bipolar disorder and borderline personality disorder among eating disorder patients. BMC Psychiatry 2013; 13:69. [PMID: 23443034 PMCID: PMC3599106 DOI: 10.1186/1471-244x-13-69] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 02/14/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Screening scales for bipolar disorder including the Mood Disorder Questionnaire (MDQ) and Bipolar Spectrum Diagnostic Scale (BSDS) have been plagued by high false positive rates confounded by presence of borderline personality disorder. This study examined the accuracy of these scales for detecting bipolar disorder among patients referred for eating disorders and explored the possibility of simultaneous assessment of co-morbid borderline personality disorder. METHODS Participants were 78 consecutive female patients who were referred for evaluation of an eating disorder. All participants completed the mood and eating disorder sections of the SCID-I/P and the borderline personality disorder section of the SCID-II, in addition to the MDQ and BSDS. Predictive validity of the MDQ and BSDS was evaluated by Receiver Operating Characteristic analysis of the Area Under the Curve (AUC). RESULTS Fifteen (19%) and twelve (15%) patients fulfilled criteria for bipolar II disorder and borderline personality disorder, respectively. The AUCs for bipolar II disorder were 0.78 (MDQ) and 0.78 (BDSD), and the AUCs for borderline personality disorder were 0.75 (MDQ) and 0.79 (BSDS). CONCLUSIONS Among patients being evaluated for eating disorders, the MDQ and BSDS show promise as screening questionnaires for both bipolar disorder and borderline personality disorder.
Collapse
Affiliation(s)
- Toshihiko Nagata
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abunoku, Osaka 545-8585, Japan
| | - Hisashi Yamada
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Alan R Teo
- Department of Internal Medicine and Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Chiho Yoshimura
- Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yuya Kodama
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abunoku, Osaka 545-8585, Japan
| | - Irene van Vliet
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|