1
|
Tomasetti C, Autullo G, Ballerini A, de Bartolomeis A, Dell'Osso B, Fiorentini A, Tonioni F, Villari V, De Berardis D. Treating depression in patients with borderline personality disorder: clinical clues on the use of antidepressants. Ann Gen Psychiatry 2024; 23:21. [PMID: 38816843 PMCID: PMC11140967 DOI: 10.1186/s12991-024-00507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Abstract
Personality disorders (PD) are described as enduring patterns of markedly deviant and pervasive inner experiences and behaviors, with onset in adolescence, which lead to severe distress or impairment. Patients suffering from major depressive disorder (MDD) display higher rates of comorbidity with personality disorders, often complicating the treatment, and worsening the outcomes. Borderline personality disorder (BPD) is the most common of PD and is frequently associated with MDD, with which shares several features. The most part of research agrees on the fact that comorbid BPD in MDD patients quite doubles the poor response to treatments. Moreover, no treatment strategy stands out currently to emerge as more effective in these cases, thus urging the call for the need of new approaches. Herein, we revise the current literature on BPD, its neurobiology and comorbidity with MDD, as well as the more recent treatment strategies used. Then, based on its pharmacology, we propose a possible role of trazodone as a valuable tool to approach comorbid BPD-MDD.
Collapse
Affiliation(s)
- Carmine Tomasetti
- Department of Mental Health, Alzheimer Center of Giulianova, Hospital "Maria SS dello Splendore", ASL Teramo, Giulianova (TE), Italy.
| | - G Autullo
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart of Rome, Rome, Italy
| | - A Ballerini
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, Florence, 50134, Italy
| | - A de Bartolomeis
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples "Federico II", Naples, Italy
| | - B Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - A Fiorentini
- Department of Neurosciences and Mental Health, Ca' Granda Ospedale Maggiore Policlinico, Fondazione Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), University of Milan, Milan, Italy
| | - F Tonioni
- Psychiatric Emergency Service, Department of Neuroscience and Mental Health, A.O.U. "Città della Salute e della Scienza", Turin, Italy
| | - V Villari
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart of Rome, Rome, Italy
| | - D De Berardis
- Department of Mental Health, Mental Health Center of Giulianova, ASL Teramo, Teramo, Italy
| |
Collapse
|
2
|
Dragasek J, Minar M, Valkovic P, Pallayova M. Factors associated with psychiatric and physical comorbidities in bipolar disorder: a nationwide multicenter cross-sectional observational study. Front Psychiatry 2023; 14:1208551. [PMID: 37559916 PMCID: PMC10407573 DOI: 10.3389/fpsyt.2023.1208551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/05/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Bipolar disorder (BD) is a chronic and disabling affective disorder with significant morbidity and mortality. Despite the high rate of psychiatric and physical health comorbidity, little is known about the complex interrelationships between clinical features of bipolar illness and comorbid conditions. The present study sought to examine, quantify and characterize the cross-sectional associations of psychiatric and physical comorbidities with selected demographic and clinical characteristics of adults with BD. METHODS A nationwide multicenter cross-sectional observational epidemiological study conducted from October 2015 to March 2017 in Slovakia. RESULTS Out of 179 study participants [median age 49 years (interquartile range IQR 38-58); 57.5% females], 22.4% were free of comorbidity, 42.5% had both psychiatric and physical comorbidities, 53.6% at least one psychiatric comorbidity, and 66.5% at least one physical comorbidity. The most prevalent were the essential hypertension (33.5%), various psychoactive substance-related disorders (21.2%), specific personality disorders (14.6%), obesity (14.5%), and disorders of lipoprotein metabolism (14%). The presence of an at least one physical comorbidity, atypical symptoms of BD, and unemployed status were each associated with an at least one psychiatric comorbidity independent of sex, early onset of BD (age of onset <35 years), BD duration and pattern of BD illness progression (p < 0.001). The presence of various psychoactive substance-related disorders, BD duration, atypical symptoms of BD, unemployed status, pension, female sex, and not using antipsychotics were each associated with an at least one physical comorbidity independent of the pattern of BD illness progression (p < 0.001). In several other multiple regression models, the use of antipsychotics (in particular, olanzapine) was associated with a decreased probability of the essential hypertension and predicted the clinical phenotype of comorbidity-free BD (p < 0.05). CONCLUSION This cross-national study has reported novel estimates and clinical correlates related to both the comorbidity-free phenotype and the factors associated with psychiatric and physical comorbidities in adults with BD in Slovakia. The findings provide new insights into understanding of the clinical presentation of BD that can inform clinical practice and further research to continue to investigate potential mechanisms of BD adverse outcomes and disease complications onset.
Collapse
Affiliation(s)
- Jozef Dragasek
- 1st Department of Psychiatry, University Hospital of Louis Pasteur and Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia
| | - Michal Minar
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Valkovic
- 2nd Department of Neurology, Faculty of Medicine, Comenius University in Bratislava, University Hospital Bratislava, Bratislava, Slovakia
- Centre of Experimental Medicine, Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Maria Pallayova
- 1st Department of Psychiatry, University Hospital of Louis Pasteur and Pavol Jozef Safarik University Faculty of Medicine, Kosice, Slovakia
- Department of Human Physiology, Faculty of Medicine, Pavol Jozef Safarik University, Kosice, Slovakia
| |
Collapse
|
3
|
Scott J, Graham A, Yung A, Morgan C, Bellivier F, Etain B. A systematic review and meta-analysis of delayed help-seeking, delayed diagnosis and duration of untreated illness in bipolar disorders. Acta Psychiatr Scand 2022; 146:389-405. [PMID: 36018259 DOI: 10.1111/acps.13490] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/25/2022] [Accepted: 08/16/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To examine the time delay between the age at onset of symptoms or episodes of bipolar disorders (BD) and the age at diagnosis of and/or receipt of clinical practice guideline recommended interventions for BD. METHODS Systematic search of five databases to identify publications from January 2000 to July 2022 that reported one or more of the following reliable and valid estimates of latency: delay in help seeking (DHS), delay in diagnosis (DD) and duration of untreated BD (DUB). Eligible studies were included in random effects meta-analyses and multivariate meta-regression was used to assess factors associated with each latency construct. RESULTS Screening of 1074 publications identified 59 eligible studies (reported in 66 publications) of >40,000 individuals that estimated DHS (8 studies), DD (20 studies) and/or DUB (45 studies). The median DHS, DD and DUB were 3.5 (IQR: 2.8, 8.48), 6.7 (IQR: 5.6, 8.9) and 5.9 years (IQR: 1.1, 8.2), respectively. Key factors associated with shorter DD included older age and residing outside North America; shorter DUB was associated with psychotic or manic onset and access to early intervention services. CONCLUSIONS Greater consensus on definitions of latency constructs and better-quality targeted research is required regarding DHS, DD and DUB. This review suggests that, while the peak age at onset of BD is 15-25, diagnosis and guideline recommended interventions (e.g., mood stabilizers) are likely to be delayed until age 25-35 years except for a minority of individuals with access to early intervention services.
Collapse
Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,Brain and Mind Centre, The University of Sydney, Sydney, Australia.,Université de Paris, Paris, France
| | - Anna Graham
- Projects and Peer Support Officer, Bipolar UK, London, UK
| | - Alison Yung
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, Victoria, Australia
| | - Catherine Morgan
- Division of Population Health, Health Service Research & Primary Care, The University of Manchester, Manchester, UK
| | - Frank Bellivier
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP.Nord, DMU Neurosciences, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Paris, France.,INSERM, UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, Paris, France
| | - Bruno Etain
- Université de Paris, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP.Nord, DMU Neurosciences, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Paris, France.,INSERM, UMR-S 1144, Optimisation Thérapeutique en Neuropsychopharmacologie, Université de Paris, Paris, France
| |
Collapse
|
4
|
Elliott M, Ragsdale JM. Stress exposure and well-being: correlates of meeting criteria for bipolar disorder, borderline personality disorder, or both. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1885-1896. [PMID: 34524518 DOI: 10.1007/s00127-021-02172-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 09/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Bipolar and borderline personality disorders share similar features, are challenging to differentiate and sometimes co-occur in the same individual. This paper compares people with bipolar, borderline, both or neither, analyzing sociodemographic characteristics, lifetime exposure to stressors, and emotional, social, and physical wellbeing to illuminate differences in life experiences associated with expressing symptoms consistent with bipolar, borderline, or both. METHODS Data were analyzed from the 2012-13 National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III), N = 36,309. Survey participants were classified as bipolar (N = 488, 1.3%), borderline (N = 1758, 4.8%), both (N = 388, 1.1%), or neither (N = 33,675, 92.8%). Differences between these groups regarding demographics, adverse childhood experiences, recent stressors, lifetime trauma, psychiatric co-morbidities, and emotional, social, and physical wellbeing were assessed with the adjusted Wald F test. RESULTS People with bipolar were more likely to also have borderline (44.3%) than the reverse (18.1%). People with both disorders were least advantaged socioeconomically, most exposed to stressors and traumas across the life course, and had the worst wellbeing emotionally, socially, and physically. Differences between people with both disorders vs. borderline only were smaller than between people with borderline vs. bipolar, although bipolar disorder was associated with considerable hardship relative to having neither disorder. CONCLUSION Borderline personality disorder alone or in combination with bipolar is associated with worse economic, social, and health outcomes than bipolar alone. Borderline can resolve with evidence-based treatment, and it is critical to correctly differentiate between the two conditions, so people with borderline and/or bipolar have the optimum chance for recovery.
Collapse
Affiliation(s)
- Marta Elliott
- Department of Sociology, University of Nevada, Reno, NV, USA.
| | | |
Collapse
|
5
|
Bayes A, Spoelma M, Parker G. Comorbid bipolar disorder and borderline personality disorder: Diagnosis using machine learning. J Psychiatr Res 2022; 152:1-6. [PMID: 35696742 DOI: 10.1016/j.jpsychires.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/14/2022] [Accepted: 05/20/2022] [Indexed: 11/18/2022]
Abstract
Comorbid bipolar disorder (BP) and borderline personality disorder (BPD) presents a diagnostic challenge in its differentiation from each condition individually. We aimed to use a machine learning (ML) approach to differentiate comorbid BP/BPD from both BP and BPD. Participants were assigned DSM diagnoses and compared on self-report measures examining personality, emotion regulation strategies and perceived parental experiences during childhood. 82 participants were assigned as BP, 52 as BPD and 53 as comorbid BP/BPD. ML-derived diagnoses had an accuracy of 79.6% in classifying BP/BPD vs. BP, and 61.7% in classifying BP/BPD vs. BPD. Stress-related paranoid ideation and other core borderline personality items were important in distinguishing BP/BPD vs. BP, whereas deficits in emotion regulation strategies were important in distinguishing BP/BPD vs. BPD. Impulsivity and anger were important across both analyses. We identified clinical variables more distinctive in comorbid BP/BPD, with superior accuracy in distinguishing from BP, and with lower accuracy compared to BPD alone. Such an additive model should assist in sharpening clinical decision making, with future machine learning examination of larger datasets likely to further improve diagnostic accuracy.
Collapse
Affiliation(s)
- Adam Bayes
- Black Dog Institute, University of New South Wales (UNSW) Sydney, 2031, Australia.
| | | | | |
Collapse
|
6
|
Parker G, Bayes A, Spoelma MJ. Why might bipolar disorder and borderline personality disorder be bonded? J Psychiatr Res 2022; 150:214-218. [PMID: 35397334 DOI: 10.1016/j.jpsychires.2022.03.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/25/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
The prevalence of comorbid bipolar disorder (BD) and borderline personality disorder (BPD) is distinctly higher in community samples than would be expected if the two conditions are independent. While there have been multiple explanations suggested for their interdependence, no clear model has been established. This paper reviews a broader set of explanations than considered previously, where relevant prevalence studies of the conditions are reported, previous explanations overviewed, and additional potential linkage causes are considered. It was found that there is unlikely to be any single determinant of the comorbid presence of BD and BPD. The most likely candidates are the artefactual impact of transdiagnostic features, with true comorbid status reflecting both pleiotropic genetic influences and environmental factors. Measurement errors in diagnostic assignment emerging from transdiagnostic features are likely to have clouded previous studies and therefore the interpretations. Comorbid BD/BPD is likely to be distinctly more common than estimated by clinicians, and clarification of the reasons why this is may well assist clinical management.
Collapse
Affiliation(s)
- Gordon Parker
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
| | - Adam Bayes
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Michael J Spoelma
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| |
Collapse
|
7
|
Zimmerman M, Balling C, Chelminski I, Dalrymple K. Patients with borderline personality disorder and bipolar disorder: a descriptive and comparative study. Psychol Med 2021; 51:1479-1490. [PMID: 32178744 DOI: 10.1017/s0033291720000215] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bipolar disorder and borderline personality disorder (BPD) are each significant public health problems. It has been frequently noted that distinguishing BPD from bipolar disorder is challenging. Consequently, reviews and commentaries have focused on differential diagnosis and identifying clinical features to distinguish the two disorders. While there is a burgeoning literature comparing patients with BPD and bipolar disorder, much less research has characterized patients with both disorders. In the current report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compare psychiatric outpatients with both BPD and bipolar disorder to patients with BPD without bipolar disorder and patients with bipolar disorder without BPD. METHODS Psychiatric outpatients presenting for treatment were evaluated with semi-structured interviews. The focus of the current study is the 517 patients with both BPD and bipolar disorder (n = 59), BPD without bipolar disorder (n = 330), and bipolar disorder without BPD (n = 128). RESULTS Compared to patients with bipolar disorder, the patients with bipolar disorder and BPD had more comorbid disorders, psychopathology in their first-degree relatives, childhood trauma, suicidality, hospitalizations, time unemployed, and likelihood of receiving disability payments. The added presence of bipolar disorder in patients with BPD was associated with more posttraumatic stress disorder in the patients as well as their family, more bipolar disorder and substance use disorders in their relatives, more childhood trauma, unemployment, disability, suicide attempts, and hospitalizations. CONCLUSIONS Patients with both bipolar disorder and BPD have more severe psychosocial morbidity than patients with only one of these disorders.
Collapse
Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | - Caroline Balling
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | - Iwona Chelminski
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| |
Collapse
|
8
|
Saunders KEA, Jones T, Perry A, Di Florio A, Craddock N, Jones I, Gordon-Smith K, Jones L. The influence of borderline personality traits on clinical outcomes in bipolar disorder. Bipolar Disord 2021; 23:368-375. [PMID: 32654345 DOI: 10.1111/bdi.12978] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Systematic reviews suggest comorbid borderline personality disorder is present in approximately 20% of individuals who have bipolar disorder, but current diagnostic systems demonstrate a move towards dimensional rather than categorical approaches to classifying personality pathology. We aimed to examine the presence and severity of borderline personality traits in bipolar I and bipolar II disorder, and to explore associations between the presence/severity of borderline personality traits and clinical outcomes in bipolar disorder. METHODS Borderline personality traits were measured in 1447 individuals with DSM-IV bipolar disorder (1008 bipolar I disorder and 439 bipolar II disorder) using the Borderline Evaluation of Severity over Time (BEST) questionnaire. Lifetime clinical outcomes were assessed via Schedules for Clinical Assessment in Neuropsychiatry (SCAN) semi-structured interview and clinical case notes. RESULTS Borderline personality traits were common in both bipolar disorder groups, with 86.2% participants reporting at least one trait. These included traits that overlap with (eg mood instability) and those that are distinct from the symptoms of bipolar disorder (eg fear of abandonment). Borderline personality traits were significantly more frequent and more severe in bipolar II disorder compared to bipolar I disorder. More severe borderline traits, and even the presence of a single borderline personality trait, were significantly associated with younger age of bipolar disorder onset and higher prevalence of lifetime alcohol misuse in both bipolar disorder groups. CONCLUSIONS The presence of comorbid borderline personality traits should be considered in the management of all patients with bipolar disorder irrespective of whether criteria for a categorical borderline personality disorder diagnosis are met.
Collapse
Affiliation(s)
- Kate E A Saunders
- University of Oxford Department of Psychiatry, Warneford Hospital, Oxford, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Tomos Jones
- Victorian Institute of Forensic Mental Health, Thomas Embling Hospital, Fairfield, Victoria, Australia
| | - Amy Perry
- Psychological Medicine, University of Worcester, Worcester, UK
| | - Arianna Di Florio
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Nick Craddock
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | - Ian Jones
- Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, UK
| | | | - Lisa Jones
- Psychological Medicine, University of Worcester, Worcester, UK
| |
Collapse
|
9
|
Wright L, Lari L, Iazzetta S, Saettoni M, Gragnani A. Differential diagnosis of borderline personality disorder and bipolar disorder: Self-concept, identity and self-esteem. Clin Psychol Psychother 2021; 29:26-61. [PMID: 33811707 DOI: 10.1002/cpp.2591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/28/2020] [Accepted: 03/26/2021] [Indexed: 01/04/2023]
Abstract
Symptoms of borderline personality disorder (BPD) and bipolar disorder (BD) often overlap. In some cases, it is difficult to conduct a differential diagnosis based only on current diagnostic criteria Therefore, it is important to find clinical factors with high discriminatory specificity that, used together with structured or semi-structured interviews, could help improve diagnostic practice. We propose that a clinical analysis of identity, self-concept and self-esteem may help distinguish the two disorders, when they are not co-morbid. Our review of the studies that analyse these constructs in BD and BPD, separately, points in the direction of qualitative differences between the two disorders. In BPD, there is a well-documented identity diffusion, and the self-concept appears predominantly negative; shifts in self-concept and self-esteem are often tied to interpersonal triggers. In BD, patients struggle with their identity, but narrative identity might be less compromised compared with BPD; the shifts in self-concept and self-esteem appear more linked to internal (i.e. mood and motivational) factors. We end the paper by discussing the implications for clinicians and ideas for future comparative research.
Collapse
Affiliation(s)
- Livia Wright
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy
| | - Lisa Lari
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy
| | | | - Marco Saettoni
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy.,Unità Funzionale Salute Mentale Adulti, ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy
| | - Andrea Gragnani
- Scuola di Psicoterapia Cognitiva SRL, Grosseto, Italy.,Unità Funzionale Salute Mentale Adulti, ASL Toscana Nord-Ovest Valle del Serchio, Pisa, Italy.,Scuola di Psicoterapia Cognitiva SRL, Rome, Italy
| |
Collapse
|
10
|
Barata PC, Godinho F, Guedes R, Silva L, Oliveira P, Serrano R, Oliveira CF, Pereira ME, Martins B, Araújo R, Borja-Santos JN, Maia T. Bipolar disorder diagnostic stability: a Portuguese multicentric study. Psychiatry Res 2020; 291:113255. [PMID: 32603931 DOI: 10.1016/j.psychres.2020.113255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/23/2020] [Accepted: 06/23/2020] [Indexed: 01/21/2023]
Affiliation(s)
- Pedro Cabral Barata
- Departmento de Psiquiatria, Hospital Prof. Dr. Fernando Fonseca, EPE, Lisboa, Portugal.
| | - Filipe Godinho
- Departmento de Psiquiatria e Saúde Mental, Hospital do Espírito Santo de Évora, Évora, Portugal
| | - Renato Guedes
- Serviço de Psiquiatria, Centro Hospitalar São João, Porto, Portugal
| | - Luís Silva
- Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Pedro Oliveira
- Serviço de Psiquiatria, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Raquel Serrano
- Departmento de Psiquiatria, Hospital Prof. Dr. Fernando Fonseca, EPE, Lisboa, Portugal
| | | | - Maria Emília Pereira
- Serviço de Psiquiatria de Adultos, Centro Hospitalar de Lisboa Ocidental, EPE, Lisboa, Portugal
| | - Beatriz Martins
- Departmento de Psiquiatria e Saúde Mental, Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Rafael Araújo
- Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - Teresa Maia
- Departmento de Psiquiatria, Hospital Prof. Dr. Fernando Fonseca, EPE, Lisboa, Portugal
| |
Collapse
|
11
|
Li B, Valles NL, Saunders J, Vyas A, Naqvi M, Shah AA. Can We Differentiate Borderline Personality Disorder from Bipolar Disorder? Psychiatr Ann 2020. [DOI: 10.3928/00485713-20191126-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
12
|
Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: a meta-analysis. Acta Psychiatr Scand 2020; 141:6-20. [PMID: 31630389 DOI: 10.1111/acps.13118] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to better understand the magnitude and consistency of the association between childhood adversity and borderline personality disorder (BPD) across case-control, epidemiological and prospective cohort studies. METHOD Following the review protocol (reference: CRD42017075179), search terms pertaining to adversity and BPD were entered into three search engines. Random-effects meta-analysis synthesised the size and consistency of the effects. RESULTS A total of 97 studies compared BPD to non-clinical (k = 40) and clinical (k = 70) controls. Meta-analysis of case-control studies indicated that individuals with BPD are 13.91 (95% CI 11.11-17.43) times more likely to report childhood adversity than non-clinical controls. This effect was smaller when considering retrospective cohort (OR: 2.59; 95% CI 0.93-7.30) and epidemiological (OR: 2.56, 95% CI 1.24-5.30) studies. Findings were significant across adversity subtypes with emotional abuse (OR: 38.11, 95% CI: 25.99-55.88) and neglect (OR: 17.73, 95% CI = 13.01-24.17) demonstrating the largest effects. Individuals with BPD were 3.15 (95% CI 2.62-3.79) times more likely to report childhood adversity than other psychiatric groups. CONCLUSIONS This meta-analysis corroborates theoretical proposals that exposure to adverse life experiences is associated with BPD. It highlights the importance of considering childhood adversity when treating people diagnosed with BPD.
Collapse
Affiliation(s)
- C Porter
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - J Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK.,Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - A Branitsky
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - W Mansell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - H Warwick
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - F Varese
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
13
|
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.
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
|
14
|
Abstract
PURPOSE OF REVIEW This article discusses the prevalence of the major mood disorders (major depressive disorder and bipolar disorder) in the community and within neurologic settings, articulates the steps taken to make a diagnosis of major depressive disorder or bipolar disorder, and reviews old and newer treatment options with proven efficacy for the treatment of these two conditions. RECENT FINDINGS New medications are available as treatment options for major depressive disorder and bipolar disorder, such as intranasal and IV ketamine, and somatic treatments, such as deep brain stimulation and vagal nerve stimulators, are being used to target treatment-resistant depression. SUMMARY Mood disorders are common in neurologic settings. They are disabling and increase morbidity and mortality. Clinicians should have a high index of suspicion if they suspect their patients seem more distressed or incapacitated than would be warranted by their neurologic disorders. If a patient does have a mood disorder, validating the patient's experience, initiating treatment, and, if necessary, referring the patient to a primary care physician or psychiatrist are appropriate steps.
Collapse
|
15
|
Borderline personality disorder and its association with bipolar spectrum and binge eating disorder in college students from South India. Asian J Psychiatr 2019; 44:20-24. [PMID: 31302438 DOI: 10.1016/j.ajp.2019.07.017] [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] [Received: 03/26/2019] [Revised: 07/07/2019] [Accepted: 07/07/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) usually emerges during adolescence and is associated with severe morbidity. Individuals with BPD are also vulnerable to develop eating disorders as well as mood disorders. OBJECTIVE To study the prevalence of borderline personality and its association with binge-eating and bipolar spectrum disorder in college students. METHODS A questionnaire based survey was conducted on a convenience sample of 500 college students (>18 years of age) in medical and engineering campus. Participants were screened on self-report measures including McLean Screening Instrument for BPD (MSI-BPD), Mood Disorder Questionnaire (MDQ) and Binge-Eating Disorder Screener (BEDS-7) for BPD, bipolar spectrum disorder (BSD) and binge-eating disorder (BED), respectively. RESULTS The prevalence of BPD was 76 (15.2%, 95% CI 12.3-18.6), BSD was 43 (8.6%, 95% CI 6.4-11.5) and BED was 48 (9.6%, 95% CI 7.2-12.6). There was a significantly higher proportion of BSD (OR 23.6, 95% CI 11.3-49.3) and BED (OR 3.4, 95% CI 1.8-6.5) among those with BPD than those without. CONCLUSIONS BPD was found in 15% of adolescents and they have higher proportion of BED and BSD. Early identification may help in planning early intervention strategies to reduce associated morbidity.
Collapse
|
16
|
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
|
17
|
Mistry S, Escott-Price V, Florio AD, Smith DJ, Zammit S. Genetic risk for bipolar disorder and psychopathology from childhood to early adulthood. J Affect Disord 2019; 246:633-639. [PMID: 30611060 DOI: 10.1016/j.jad.2018.12.091] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/29/2018] [Accepted: 12/24/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Studying the phenotypic manifestations of increased genetic liability for Bipolar Disorder (BD) can increase understanding of this disorder. AIMS We assessed whether genetic risk for BD was associated with childhood psychopathology and features of hypomania in young adulthood within a large population-based birth cohort. METHODS We used data from the second Psychiatric Genetics Consortium Genome Wide Association Study (GWAS) for Bipolar Disorder to construct a polygenic risk score (PRS) for each individual in the Avon Longitudinal Study of Parents and Children (ALSPAC). Linear and logistic regression models were used to assess associations between the BD-PRS and emotional/behavioural difficulties, attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) traits in childhood, as well as hypomania in early adulthood (sample sizes from 2654 to 6111). RESULTS The BD-PRS was not associated with total hypomania score, but was weakly associated with a binary measure of hypomania (OR = 1.13, 95%CI 0.98,1.32; p = 0.097), and particularly at higher hypomania symptom thresholds (strongest evidence OR = 1.33, 95%CI 1.07, 1.65; p = 0.01). The BD-PRS was also associated with ADHD (OR = 1.31, 95%CI 1.10, 1.57; p = 0.018), but not with other childhood psychopathology. LIMITATIONS The PRS only captures common genetic variation and currently explains a relatively small proportion of the variance for BD. CONCLUSIONS The BD-PRS was associated with ADHD in childhood, and weakly with adult hypomania, but not with other psychopathology examined. Our findings suggest that genetic risk for BD does not appear to manifest in childhood to the same extent as schizophrenia genetic risk has been reported to do.
Collapse
Affiliation(s)
- Sumit Mistry
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Maindy Road, CF24 4HQ, UK.
| | - Valentina Escott-Price
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Maindy Road, CF24 4HQ, UK
| | - Arianna D Florio
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Maindy Road, CF24 4HQ, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, 1 Lilybank Gardens, University of Glasgow, UK
| | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Maindy Road, CF24 4HQ, UK; Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, UK
| |
Collapse
|
18
|
Khosravani V, Mohammadzadeh A, Sharifi Bastan F, Amirinezhad A, Amini M. Early maladaptive schemas and suicidal risk in inpatients with bipolar disorder. Psychiatry Res 2019; 271:351-359. [PMID: 30529318 DOI: 10.1016/j.psychres.2018.11.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 12/16/2022]
Abstract
The present study aimed to assess the associations of early maladaptive schemas (EMSs) and clinical factors (hypomanic/manic and depressive symptoms) with suicidal risk (current suicidal ideation and lifetime suicide attempts) in inpatients with bipolar disorder (BD). One hundred inpatients with BD completed the Young Schema Questionnaire-Short Form (YSQ-SF), the Bipolar Depression Rating Scale (BDRS), the Young Mania Rating Scale (YMRS), and the Beck Scale for Suicide Ideation (BSSI). 59% of patients had lifetime suicide attempts and 59% showed high suicidal risk (BSSI ≥ 6). BD patients with lifetime suicide attempts had higher scores on the entitlement and social isolation schemas, depression, and hypomanic/manic symptoms than those without such attempts. Patients with high suicidal risk had higher levels of depressive and hypomanic/manic symptoms as well as some EMSs than those without high suicidal risk. Logistic regression analyses revealed that hypomanic/manic symptoms as well as the entitlement and defectiveness schemas were significantly associated with current suicidal ideation. Also, the entitlement and social isolation schemas were associated with lifetime suicide attempts. These results suggest that the entitlement, social isolation, and defectiveness schemas may relate to suicidal risk in patients with BD.
Collapse
Affiliation(s)
- Vahid Khosravani
- Clinical Research Development Center of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | | | | | - Ali Amirinezhad
- Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran
| | - Marziyeh Amini
- Clinical Psychology, Mohaghegh Ardebili University, Ardabil, Iran
| |
Collapse
|
19
|
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
|
20
|
de la Vega D, Piña A, Peralta FJ, Kelly SA, Giner L. A Review on the General Stability of Mood Disorder Diagnoses Along the Lifetime. Curr Psychiatry Rep 2018; 20:29. [PMID: 29607445 DOI: 10.1007/s11920-018-0891-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to review the most recent literature regarding diagnostic stability of mood disorders, focusing on epidemiological, clinical-psychopathological, and neurobiological data for unipolar and bipolar affective disorders. RECENT FINDINGS Unipolar depression follows a chronic course in at least half of all cases and presents a considerable diagnostic stability across all age ranges. Studies using latent class analysis are allowing improved profiling of depressive subtypes and assessment of their prevalence. Advances have been made in our understanding of the neurobiological underpinnings of depression, with data highlighting the roles of amyloid deposits, the ApoE4 allele, and atrophy of the anterior hippocampus or frontal cortex. The diagnostic instability of bipolar disorder is manifest in the early years, seen in both the extent of diagnostic delay and the high rate of diagnostic conversion from unipolar depression. Regarding disruptive mood dysregulation disorder, we have little data to date, but those which exist indicate a high rate of comorbidity and minimal diagnostic stability for this disorder. Diagnostic stability varies substantially among mood disorders, which would be related to the validity of current diagnostic categories and our diagnostic accuracy.
Collapse
Affiliation(s)
- Diego de la Vega
- Servicio Andaluz de Salud, Unidad de Hospitalización de Salud Mental, Unidad de Gestión Clínica de Salud Mental del Hospital Virgen Macarena, 41009, Seville, Spain.
| | - Ana Piña
- Servicio Andaluz de Salud, Unidad de Hospitalización de Salud Mental, Unidad de Gestión Clínica de Salud Mental del Hospital Virgen Macarena, 41009, Seville, Spain
| | - Francisco J Peralta
- Servicio Andaluz de Salud, Unidad de Hospitalización de Salud Mental, Unidad de Gestión Clínica de Salud Mental del Hospital Virgen Macarena, 41009, Seville, Spain
| | - Sam A Kelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lucas Giner
- Department of Psychiatry, Universidad de Sevilla, Seville, Spain
| |
Collapse
|
21
|
Yapici Eser H, Kacar AS, Kilciksiz CM, Yalçinay-Inan M, Ongur D. Prevalence and Associated Features of Anxiety Disorder Comorbidity in Bipolar Disorder: A Meta-Analysis and Meta-Regression Study. Front Psychiatry 2018; 9:229. [PMID: 29997527 PMCID: PMC6030835 DOI: 10.3389/fpsyt.2018.00229] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/11/2018] [Indexed: 12/23/2022] Open
Abstract
Objective: Bipolar disorder is highly comorbid with anxiety disorders, however current and lifetime comorbidity patterns of each anxiety disorder and their associated features are not well studied. Here, we aimed to conduct a meta-analysis and meta-regression study of current evidence. Method: We searched PubMed to access relevant articles published until September 2015, using the keywords "Bipolar disorder" or "Affective Psychosis" or "manic depressive" separately with "generalized anxiety," "panic disorder," "social phobia," "obsessive compulsive," and "anxiety." Variables for associated features and prevalence of anxiety disorders were carefully extracted. Results: Lifetime any anxiety disorder comorbidity in BD was 40.5%; panic disorder (PD) 18.1%, generalized anxiety disorder (GAD) 13.3%, social anxiety disorder (SAD) 13.5% and obsessive compulsive disorder (OCD) 9.7%. Current any anxiety disorder comorbidity in BD is 38.2%; GAD is 15.2%, PD 13.3%, SAD 11.7%, and OCD 9.9%. When studies reporting data about comorbidities in BDI or BDII were analyzed separately, lifetime any anxiety disorder comorbidity in BDI and BDII were 38% and 34%, PD was 15% and 15%, GAD was 14% and 16.6%, SAD was 8% and 13%, OCD was 8% and 10%, respectively. Current any DSM anxiety disorder comorbidity in BDI or BDII were 31% and 37%, PD was 9% and 13%, GAD was 8% and 12%, SAD was 7% and 11%, and OCD was 8% and 7%, respectively. The percentage of manic patients and age of onset of BD tended to have a significant impact on anxiety disorders. Percentage of BD I patients significantly decreased the prevalence of panic disorder and social anxiety disorder. A higher rate of substance use disorder was associated with greater BD-SAD comorbidity. History of psychotic features significantly affected current PD and GAD. Conclusions: Anxiety disorder comorbidity is high in BD with somewhat lower rates in BDI vs BDII. Age of onset, substance use disorders, and percentage of patients in a manic episode or with psychotic features influences anxiety disorder comorbidity.
Collapse
Affiliation(s)
- Hale Yapici Eser
- School of Medicine, Koç University, Sariyer, Turkey.,Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Anil S Kacar
- Research Center for Translational Medicine, Koç University, Istanbul, Turkey
| | - Can M Kilciksiz
- School of Medicine, Koç University, Sariyer, Turkey.,Psychotic Disorders Division, McLean Hospital, Belmont, CA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | | | - Dost Ongur
- Psychotic Disorders Division, McLean Hospital, Belmont, CA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
22
|
Anxiety disorders and childhood maltreatment as predictors of outcome in bipolar disorder. J Affect Disord 2018; 225:337-341. [PMID: 28843916 DOI: 10.1016/j.jad.2017.08.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 06/29/2017] [Accepted: 08/14/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Comorbid anxiety disorders and childhood maltreatment have each been linked with unfavourable outcomes in people with bipolar disorder. Because childhood maltreatment is associated with anxiety disorders in this population, their respective predictive value remains to be determined. METHODS In 174 adults with bipolar disorder, we assessed childhood maltreatment using the Childhood Trauma Questionnaire and lifetime anxiety disorders with the MINI International Neuropsychiatric Interview. We constructed an overall index of severity of bipolar disorder as a sum of six indicators (unemployment, psychotic symptoms, more than five manic episodes, more than five depressive episodes, suicide attempt, and hospital admission). We tested the relationship between childhood maltreatment, the number of anxiety disorders and the overall severity index using ordered logistic regression. RESULTS The number of lifetime anxiety disorders was associated with the overall severity index (OR = 1.43, 95%CI = 1.01-2.04, p = 0.047). This relationship was only slightly attenuated when controlled for childhood maltreatment (OR = 1.39, 95%CI = 0.97-2.00, p = 0.069). The relationship between childhood maltreatment and the overall severity index was not statistically significant (OR = 1.26, 95%CI = 0.92-1.74, p = 0.151). Secondary analyses revealed that childhood maltreatment was associated with suicide attempts (OR = 1.70, 95%CI = 1.15-2.51, p = 0.008) and obsessive compulsive disorder was associated with the overall severity index (OR = 9.56, 95%CI = 2.20-41.47, p = 0.003). LIMITATIONS This was a cross-sectional study with a moderate-sized sample recruited from a specialist program. CONCLUSIONS While comorbid anxiety disorders are associated with the overall severity of bipolar disorder, childhood maltreatment is specifically associated with suicide attempts. Clinicians should systematically assess both factors. Interventions to improve outcomes of people with bipolar disorder with comorbid anxiety disorders and history of childhood maltreatment are needed.
Collapse
|
23
|
Mistry S, Zammit S, Price VE, Jones HJ, Smith DJ. Borderline personality and attention-deficit hyperactivity traits in childhood are associated with hypomanic features in early adulthood. J Affect Disord 2017; 221:246-253. [PMID: 28662455 DOI: 10.1016/j.jad.2017.06.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/08/2017] [Accepted: 06/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is limited understanding of the symptomatic development of bipolar disorder from childhood to early adulthood. AIMS We assessed whether borderline personality disorder traits, ADHD, and emotional, behavioural and social difficulties during childhood were associated with hypomania assessed in young adulthood. METHOD We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), to examine associations between measures of childhood psychopathology and lifetime hypomanic features assessed at age 22-23 years using the Hypomania Checklist-32 (HCL-32; n = 3372). We also conducted a factor analysis of the HCL to identify latent constructs underlying hypomania, and the extent to which childhood psychopathology was associated with these. RESULTS We identified two factors of the HCL corresponding to energy/mood and risk-taking/irritability. There was evidence of association between childhood borderline personality disorder traits and both hypomania factors, with evidence that the association was stronger with the risk-taking/irritability factor. All individual borderline traits, with the exception of fear of abandonment, were associated with hypomania. There was also evidence of association between most other measures of childhood psychopathology (ADHD, hyperactivity, conduct problems, peer relationship problems and reduced prosocial behaviour) and the risk-taking/irritability factor, but much less consistent evidence of association with the energy/mood factor. LIMITATIONS The HCL cannot diagnose bipolar disorder and may be subject to reporting bias. CONCLUSIONS A broad range of childhood psychopathologies may represent early markers of risk for hypomania. Further studies are required to understand the mechanisms underlying these associations, and to inform earlier detection of bipolar disorder.
Collapse
Affiliation(s)
- Sumit Mistry
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK.
| | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK; Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, UK
| | - Valentina-Escott Price
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Hannah J Jones
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, I Lilybank Gardens, University of Glasgow, UK
| |
Collapse
|
24
|
Blanco C, Compton WM, Saha TD, Goldstein BI, Ruan WJ, Huang B, Grant BF. Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions - III. J Psychiatr Res 2017; 84:310-317. [PMID: 27814503 PMCID: PMC7416534 DOI: 10.1016/j.jpsychires.2016.10.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/07/2016] [Accepted: 10/06/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objective of this study was to present 12-month and lifetime prevalence, correlates, comorbidity, treatment and disability of DSM-5 bipolar I disorder. METHODS Nationally representative U.S. adult sample (N = 36,309), the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions - III. RESULTS Prevalences of 12-month and lifetime DSM-5 bipolar I disorder were 1.5% and 2.1% and did not differ between men (1.6% and 2.2%) and women (1.5% and 2.0%). Prevalences of bipolar I disorder were greater among Native Americans, and lower among Blacks, Hispanics and Asians/Pacific Islanders than whites. Rates were also lower among younger than older individuals, those previously married than currently married and with lower education and income relative to higher education and income. Bipolar I disorder was more strongly related to borderline and schizotypal personality disorders (adjusted odds ratios (AORS) = 2.2-4.7)), than to anxiety disorders (AORs = 1.3-2.9), and substance use disorders (AORs = 1.3-2.1) overall and among men and women. Quality of life was lower among individuals with bipolar I disorder relative to those without the disorder. Treatment rates among individuals with bipolar I disorder were low in the total sample (46%, SE = 2.63), among men (36.7%, SE = 3.82) and among women (55.8%, SE = 3.32). CONCLUSIONS Bipolar I disorder continues to be common disabling and highly comorbid disorder among men and women, contributing substantially to low quality of life and burden of disease in our society.
Collapse
Affiliation(s)
- Carlos Blanco
- Division of Epidemiology, Service and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd., Rockville, MD, 20852, USA.
| | - Wilson M. Compton
- Division of Epidemiology, Service and Prevention Research, National Institute on Drug Abuse, 6001 Executive Blvd. Rockville, MD 20852
| | - Tulshi D. Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| | - Benjamin I. Goldstein
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room FG 53, Toronto, Canada, M4N 3M5
| | - W. June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD, 20852, USA.
| | - Bridget F. Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Rockville, MD 20852
| |
Collapse
|
25
|
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
|
26
|
Cohen LJ, Tanis T, Ardalan F, Yaseen Z, Galynker I. Maladaptive interpersonal schemas as sensitive and specific markers of borderline personality disorder among psychiatric inpatients. Psychiatry Res 2016; 242:395-403. [PMID: 27394052 DOI: 10.1016/j.psychres.2016.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/15/2022]
Abstract
Diagnostic criteria for borderline personality disorder (BPD) and mood and psychotic disorders characterized by major mood episodes (i.e., major depressive, bipolar and schizoaffective disorder) share marked overlap in symptom presentation, complicating differential diagnosis. The current study tests the hypothesis that maladaptive interpersonal schemas (MIS) are characteristic of BPD, but not of the major mood disorders. One hundred psychiatric inpatients were assessed by SCID I, SCID II and the Young Schema Questionnaire (YSQ-S2). Logistic regression analyses tested the association between MIS (measured by the YSQ-S2) and BPD, bipolar, major depressive and schizoaffective disorder. Receiver operator characteristic (ROC) curve analyses assessed the sensitivity and specificity of MIS as a marker of BPD. After covariation for comorbidity with each of the 3 mood disorders, BPD was robustly associated with 4 out of 5 schema domains. In contrast, only one of fifteen regression analyses demonstrated a significant association between any mood disorder and schema domain after covariation for comorbid BPD. ROC analyses of the 5 schema domains suggested Disconnection/Rejection had the greatest power for identification of BPD cases. These data support the specific role of maladaptive interpersonal schemas in BPD and potentially contribute to greater conceptual clarity about the distinction between BPD and the major mood disorders.
Collapse
Affiliation(s)
- Lisa J Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States.
| | - Thachell Tanis
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
| | - Firouz Ardalan
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
| | - Zimri Yaseen
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, 1st Avenue & East 16th Street, New York, NY 10003, United States
| |
Collapse
|
27
|
The prevalence and predictors of bipolar and borderline personality disorders comorbidity: Systematic review and meta-analysis. J Affect Disord 2016; 195:105-18. [PMID: 26881339 DOI: 10.1016/j.jad.2016.01.040] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/04/2016] [Accepted: 01/24/2016] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Data about the prevalence of borderline personality (BPD) and bipolar (BD) disorders comorbidity are scarce and the boundaries remain controversial. We conducted a systematic review and meta-analysis investigating the prevalence of BPD in BD and BD in people with BPD. METHODS Two independent authors searched MEDLINE, Embase, PsycINFO and the Cochrane Library from inception till November 4, 2015. Articles reporting the prevalence of BPD and BD were included. A random effects meta-analysis and meta-regression were conducted. RESULTS Overall, 42 papers were included: 28 considering BPD in BD and 14 considering BD in BPD. The trim and fill adjusted analysis demonstrated the prevalence of BPD among 5273 people with BD (39.94 ± 11.78 years, 44% males) was 21.6% (95% CI 17.0-27.1). Higher comorbid BPD in BD were noted in BD II participants (37.7%, 95% CI 21.9-56.6, studies=6) and North American studies (26.2%, 95% CI 18.7-35.3, studies=11). Meta regression established that a higher percentage of males and higher mean age significantly (p<0.05) predicted a lower prevalence of comorbid BPD in BD participants. The trim and fill adjusted prevalence of BD among 1814 people with BPD (32.22 ± 7.35 years, 21.5% male) was 18.5% (95% CI 12.7-26.1). LIMITATIONS Paucity of longitudinal/control group studies and accurate treatment records. CONCLUSIONS BPD-BD comorbidity is common, with approximately one in five people experiencing a comorbid diagnosis. Based on current diagnostic constructs, and a critical interpretation of results, both qualitative and quantitative syntheses of the evidence prompt out the relevance of differences rather similarities between BD and BPD.
Collapse
|
28
|
Pardo JV. Adjunctive vagus nerve stimulation for treatment-resistant bipolar disorder: managing device failure or the end of battery life. BMJ Case Rep 2016; 2016:bcr-2015-213949. [PMID: 26951440 DOI: 10.1136/bcr-2015-213949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The vagus nerve stimulation (VNS) device is used not only to treat refractory seizure disorders but also mood disorders; the latter indication received CE Mark approval in 2001 and Food and Drug Administration approval in 2005. Original estimates for the end of battery life (EOBL) were approximately 6-10 years. Many neuropsychiatric patients have or will soon face EOBL. A patient with severe, life-threatening, treatment-resistant bipolar disorder underwent 9 years of stable remission following 20 months of adjunctive VNS. The device ceased operation at EOBL. Because of logistical issues, re-initiation of VNS was delayed over several months. The patient relapsed with depression, mania and mixed states, and regained remission 17 months after device replacement. This case dictates prudence in managing stable patients in remission with VNS. If the device malfunctions, urgent surgical replacement is warranted with subsequent rapid titration to previous parameters as tolerated. Several months' delay may trigger relapse and prove difficult to re-establish remission.
Collapse
Affiliation(s)
- José V Pardo
- Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA Minneapolis Veterans Health Care System, Minneapolis, Minnesota, USA
| |
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW The purpose of this article is to review recent findings regarding the comorbidity of bipolar disorder with borderline personality disorder (BPD). The conceptualization of the comorbid condition is explored in the context of complexity theory. RECENT FINDINGS Recent studies highlight distinguishing features between the two disorders. The course of illness of the comorbid condition is generally considered to be more debilitating than bipolar disorder alone. SUMMARY Some of the differentiating features of bipolar disorder and BPD are highlighted. It is also crucial to consider a co-morbid diagnosis as worse outcomes may be anticipated than for bipolar disorder alone. The concept of 'emotional frailty' is introduced and the comorbid bipolar disorder-BPD condition is considered an expression of this syndrome.
Collapse
|
30
|
Kung S, Palmer BA, Lapid MI, Poppe KA, Alarcon RD, Frye MA. Screening for bipolar disorders: Clinical utilization of the Mood Disorders Questionnaire on an inpatient mood disorders unit. J Affect Disord 2015; 188:97-100. [PMID: 26344754 DOI: 10.1016/j.jad.2015.08.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 08/23/2015] [Accepted: 08/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Mood Disorders Questionnaire (MDQ) is a widely used screening instrument for bipolar disorders. The MDQ has seldom been used in the inpatient setting, and we report a clinical, real-world inpatient validation. METHODS Between April 2011 and August 2013, patients admitted to the inpatient Mood Disorders Unit completed an MDQ as part of their admission process. Patients with a discharge diagnosis of unipolar or bipolar disorders were included. The sensitivity and specificity were calculated for each number of questionnaire items checked positive, as well as the symptoms clustered around the same time and with moderate impairment in functioning. RESULTS A total of 1330 patient MDQ's were identified, and after excluding incomplete MDQ's and non-unipolar or bipolar diagnoses (e.g. anxiety, adjustment, or schizoaffective diagnoses), 860 MDQ's remained. One hundred fifty four patients (18%) were diagnosed with bipolar disorder, and 706 (82%) with unipolar depressive disorder. The average length of stay was 7.6 days. The optimal cutoff score was 8, resulting in a sensitivity/specificity of 86%/71%, compared to 92%/64% with a cutoff of 7. LIMITATIONS Retrospective study using clinical diagnoses instead of research instrument diagnoses. CONCLUSIONS The sensitivity of the MDQ in an inpatient mood disorders setting was higher than an outpatient psychiatric population, but the specificity was lower. A cutoff of 8 instead of the recommended outpatient cutoff of 7 was optimal. In today's busy clinical practices, a screening instrument for bipolar disorder is still useful, and the MDQ can be effectively utilized on an inpatient psychiatry mood disorders unit.
Collapse
Affiliation(s)
- Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Brian A Palmer
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | | | - Renato D Alarcon
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|