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Temes CM, Boccagno C, Gold AK, Kobaissi H, Hsu I, Montinola S, Sylvia LG. Comorbidity of bipolar disorder and borderline personality disorder: Phenomenology, course, and treatment considerations. Bipolar Disord 2024. [PMID: 39034111 DOI: 10.1111/bdi.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
AIM Bipolar disorder (BD) and borderline personality disorder (BPD) are both serious psychiatric conditions that elevate the risk for harmful outcomes. Although these conditions represent distinct diagnostic entities, existing research suggests that approximately 20% of individuals with BD meet the criteria for comorbid BPD. Individuals with comorbid BD/BPD appear to have a markedly more severe and phenomenologically distinct clinical course when compared with those with BD alone. However, treatments have generally not been tested in this specific population, and currently, no formal treatment guidelines exist for this subgroup of patients. METHOD In the current paper, we review the epidemiological and descriptive research characterizing those with comorbid BD/BPD and discuss the impact of this comorbidity on psychosocial treatment. We also review current findings on evidence-based treatments for BD and BPD that show promise in treating those with comorbid BD/BPD. RESULTS In our review of the literature, we highlight the importance of recognizing this comorbidity and discuss avenues for developing and integrating evidence-based treatment approaches for this understudied clinical population. CONCLUSIONS Although formal trials of interventions targeted to comorbid BD/BPD are limited, there is promising evidence regarding the possibility of using or integrating existing evidence-based approaches for this population. There are also several areas of clinical practice improvement and future research directions that stem from this literature.
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Affiliation(s)
- Christina M Temes
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Chelsea Boccagno
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
- Harvard T.H. Chan School for Public Health, Department of Epidemiology, Boston, Massachusetts, USA
| | - Alexandra K Gold
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
| | - Hadi Kobaissi
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
| | - Ingrid Hsu
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
| | - Sofia Montinola
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
| | - Louisa G Sylvia
- Massachusetts General Hospital, Dauten Center for Bipolar Treatment Innovation, Boston, Massachusetts, USA
- Harvard Medical School, Department of Psychiatry, Boston, Massachusetts, USA
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2
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Nazari MJ, Shalbafan M, Eissazade N, Khalilian E, Vahabi Z, Masjedi N, Ghidary SS, Saadat M, Sadegh-Zadeh SA. A machine learning approach for differentiating bipolar disorder type II and borderline personality disorder using electroencephalography and cognitive abnormalities. PLoS One 2024; 19:e0303699. [PMID: 38905185 PMCID: PMC11192371 DOI: 10.1371/journal.pone.0303699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/29/2024] [Indexed: 06/23/2024] Open
Abstract
This study addresses the challenge of differentiating between bipolar disorder II (BD II) and borderline personality disorder (BPD), which is complicated by overlapping symptoms. To overcome this, a multimodal machine learning approach was employed, incorporating both electroencephalography (EEG) patterns and cognitive abnormalities for enhanced classification. Data were collected from 45 participants, including 20 with BD II and 25 with BPD. Analysis involved utilizing EEG signals and cognitive tests, specifically the Wisconsin Card Sorting Test and Integrated Cognitive Assessment. The k-nearest neighbors (KNN) algorithm achieved a balanced accuracy of 93%, with EEG features proving to be crucial, while cognitive features had a lesser impact. Despite the strengths, such as diverse model usage, it's important to note limitations, including a small sample size and reliance on DSM diagnoses. The study suggests that future research should explore multimodal data integration and employ advanced techniques to improve classification accuracy and gain a better understanding of the neurobiological distinctions between BD II and BPD.
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Affiliation(s)
- Mohammad-Javad Nazari
- Computer Science and Mathematics Department, Amirkabir University of Technology, Tehran, Iran
| | - Mohammadreza Shalbafan
- Department of Psychiatry, Psychosocial Health Research Institute (PHRI), Mental Health Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Institute for Cognitive Sciences Studies, Brain and Cognition Clinic, Tehran, Iran
| | - Negin Eissazade
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Khalilian
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Vahabi
- Neuropsychiatry Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Masjedi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Shiry Ghidary
- Computer Science and Mathematics Department, Amirkabir University of Technology, Tehran, Iran
| | - Mozafar Saadat
- Department of Mechanical Engineering, School of Engineering, University of Birmingham, Birmingham, United Kingdom
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3
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Danon M, Duriez P, Gorwood P. Three clinical indicators of borderline personality disorder in anorexia nervosa: A pilot study. L'ENCEPHALE 2024; 50:4-10. [PMID: 36411120 DOI: 10.1016/j.encep.2022.09.006] [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: 06/02/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Co-occurrence of Anorexia Nervosa (AN) and borderline personality disorder (BPD) is frequent (8%-40%) and associated with specificities that impact the treatment process. Lifetime history of suicide attempt (HAS), substance use disorder (SUD) and the binge-purging subtype (B-P) might be good markers of such comorbidity. We made the hypothesis that in patients with AN, the presence of HAS, SUD and B-P have sufficient predictive power to efficiently detect an associated BPD comorbidity. METHODS After a case report analysis on a pilot sample of 119 patients with AN, we performed a cross-sectional analysis on a confirmatory sample of 84 patients with AN in a single center specialized in eating disorders systematically assessing HAS, SUD, B-P and BPD using the Mini International Neuropsychiatric Interview for DSM-5 and the Diagnostic Interview for Borderline (DIB-R). RESULTS B-P had a 100% negative predictive value, and the combination of SUD plus HAS had a 100% positive predictive value. On a quantitative level, B-P, HAS and SUD were independent explanatory factors of the DIB-R total score. CONCLUSIONS The main limitations were the low number of patients, the single center analyses, the potential overlapping of assessments and the fact that data were exclusively declarative. In this study, every patient with B-P, SUD and HAS had been diagnosed with BPD.
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Affiliation(s)
- M Danon
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France.
| | - P Duriez
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France
| | - P Gorwood
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm U1266, 75014 Paris, France; GHU Paris psychiatrie et neurosciences, CMME, hôpital Sainte-Anne, 75014 Paris, France
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4
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Socada JL, Söderholm JJ, Rosenström T, Lahti J, Ekelund J, Isometsä ET. Affect dimensions and variability during major depressive episodes: Ecological momentary assessment of unipolar, bipolar, and borderline patients and healthy controls. J Psychiatr Res 2024; 170:408-416. [PMID: 38218014 DOI: 10.1016/j.jpsychires.2024.01.010] [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: 08/10/2023] [Revised: 12/21/2023] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
Differentiating major depressive episodes (MDEs) of major depressive disorder (MDD), bipolar disorder (MDE/BD) and the MDEs comorbid with borderline personality disorder (MDE/BPD) is crucial for appropriate treatment, and knowledge of phenomenological differences may aid this. However, studies comparing affect experiences of these three patient groups and healthy subjects are scarce. In our study, participants (N = 114), including patients with MDD (n = 34), MDE/BD (n = 27), and MDE/BPD (n = 24), and healthy controls (HC, n = 29) responded to ecological momentary assessment (EMA) with ten circumplex model affect items ten times daily for seven days (7709 recordings). Explorative factor analysis resulted in two affect dimensions. The positive dimension included active, excited, cheerful (high arousal), and content (low arousal) affects, and the negative dimension irritated, angry, and nervous (high arousal) affects. Relative to HC, patients reported 3.5-fold negative affects (mean MDD 1.36 (SD 0.92), MDE/BD 1.43 (0.76), MDE/BPD 1.81 (0.95) vs. HC 0.44 (0.49) (p < 0.01)) but 0.5-fold positive affects (2.01 (0.90), 1.95 (0.89), 2.24 (1.03), vs. 3.2 (0.95), respectively (p < 0.01)). We used multilevel modelling. Negative-affect within-individual stability was lowest in MDE/BPD and highest in MDD. Negative affect predicted concurrent positive affect more in MDE/BPD than in MDD. Moderate size of subcohorts and no inpatients were limitations. Despite apparently similar MDEs, affective experiences may differ between BPD, BD, and MDD patients. Clinical subgroups of patients with depression may vary in affective instability and concurrent presence of negative and positive affects during depression.
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Affiliation(s)
- J Lumikukka Socada
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - John J Söderholm
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari Lahti
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Folkhälsan Research Centre, Helsinki, Finland
| | - Jesper Ekelund
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki T Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
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5
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Anona K, Olaomi O, Udegbe E, Uwumiro F, Tuaka EB, Okafor N, Adeyinka A, Obijuru C, Okpujie V, Bojerenu M, Opeyemi M. Co-occurrence of bipolar disorder and personality disorders in the United States: Prevalence, suicidality, and the impact of substance abuse. J Affect Disord 2024; 345:1-7. [PMID: 37848089 DOI: 10.1016/j.jad.2023.10.087] [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: 06/15/2023] [Revised: 10/07/2023] [Accepted: 10/13/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND This study investigates prevalence rates of specific personality disorders (PDs) in individuals with bipolar disorder (BD) and their impact on substance abuse and suicidality, addressing existing gaps in the literature. METHODS Using Nationwide Inpatient Sample data (2016-2020), adult hospitalizations for BD with coexisting PDs were analyzed. Study variables were defined using ICD-10-CM codes. Prevalence of PD were reported as cases per 100,000 BD admissions. Regression models assessed the association between substance abuse and suicidality. RESULTS About 993,000 admissions for BD were analyzed. The cohort was predominantly Caucasian (70.5 %) with higher female representation (54.5 %). The mean age was 41 years. 89.4 % of individuals had a Charlson Comorbidity Index score ≤ 1. The most common diagnostic subtype was manic episode of BD with or without psychotic features (32.3 %). Coexisting PDs were observed in 12.2 % of the population, with borderline PD (8.2 %) and antisocial PD (2.6 %) being most prevalent. Substance abuse was common (44.8 %), with cannabis (23.8 %), alcohol (19.4 %), cocaine (10.5 %), and opioids (9.6 %) being most reported. Substance abuse was higher in individuals with BD and PD (50 %) compared to BD alone (44.1 %). 596 suicide attempts were recorded (60 per 100,000 BD admissions). Substance abuse and coexisting PD in bipolar individuals elevated the likelihood of attempts (P < 0.001). LIMITATIONS Use of administrative data (retrospective, inpatient); treatment not studied. CONCLUSION The study reveals a notable prevalence of PDs in individuals with BD, with increased likelihood of substance abuse and suicide attempts in those with coexisting BD and PD compared to BD alone.
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Affiliation(s)
- Kenechukwu Anona
- Greater Manchester Mental Health National Health Service Foundation Trust, UK
| | | | | | - Fidelis Uwumiro
- Jos University Teaching Hospital, Jos, Plateau State, Nigeria.
| | - Ebere-Bank Tuaka
- Rivers State University Teaching Hospital, Port Harcourt, Nigeria
| | - Nnenna Okafor
- All Saints University College of Medicine, Belair Kingstown, Saint Vincent and the Grenadines
| | | | - Chinwendu Obijuru
- College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu State, Nigeria
| | - Victory Okpujie
- College of Medicine, University of Benin, Benin City, Edo State, Nigeria
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6
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Nau CL, Braciszewski JM, Rossom RC, Penfold RB, Coleman KJ, Simon GE, Hong B, Padilla A, Butler RK, Chen A, Waters HC. Assessment of Disruptive Life Events for Individuals Diagnosed With Schizophrenia or Bipolar I Disorder Using Data From a Consumer Credit Reporting Agency. JAMA Psychiatry 2023:2804639. [PMID: 37163288 PMCID: PMC10173103 DOI: 10.1001/jamapsychiatry.2023.1179] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Importance There is a dearth of population-level data on major disruptive life events (defined here as arrests by a legal authority, address changes, bankruptcy, lien, and judgment filings) for patients with bipolar I disorder (BPI) or schizophrenia, which has limited studies on mental health and treatment outcomes. Objective To conduct a population-level study on disruptive life events by using publicly available data on disruptive life events, aggregated by a consumer credit reporting agency in conjunction with electronic health record (EHR) data. Design, Setting, and Participants This study used EHR data from 2 large, integrated health care systems, Kaiser Permanente Southern California and Henry Ford Health. Cohorts of patients diagnosed from 2007 to 2019 with BPI or schizophrenia were matched 1:1 by age at analysis, age at diagnosis (if applicable), sex, race and ethnicity, and Medicaid status to (1) an active comparison group with diagnoses of major depressive disorder (MDD) and (2) a general health (GH) cohort without diagnoses of BPI, schizophrenia, or MDD. Patients with diagnoses of BPI or schizophrenia and their respective comparison cohorts were matched to public records data aggregated by a consumer credit reporting agency (98% match rate). Analysis took place between November 2020 and December 2022. Main Outcomes and Measures The differences in the occurrence of disruptive life events among patients with BPI or schizophrenia and their comparison groups. Results Of 46 167 patients, 30 008 (65%) had BPI (mean [SD] age, 42.6 [14.2] years) and 16 159 (35%) had schizophrenia (mean [SD], 41.4 [15.1] years). The majoriy of patients were White (30 167 [65%]). In addition, 18 500 patients with BPI (62%) and 6552 patients with schizophrenia (41%) were female. Patients with BPI were more likely to change addresses than patients in either comparison cohort (with the incidence ratio being as high as 1.25 [95% CI, 1.23-1.28]) when compared with GH cohort. Patients with BPI were also more likely to experience any of the financial disruptive life events with odds ratio ranging from 1.15 [95% CI, 1.07-1.24] to 1.50 [95% CI, 1.42-1.58]). The largest differences in disruptive life events were seen in arrests of patients with either BPI or schizophrenia compared with GH peers (3.27 [95% CI, 2.84-3.78] and 3.04 [95% CI, 2.57-3.59], respectively). Patients with schizophrenia had fewer address changes and were less likely to experience a financial event than their matched comparison cohorts. Conclusions and Relevance This study demonstrated that data aggregated by a consumer credit reporting agency can support population-level studies on disruptive life events among patients with BPI or schizophrenia.
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Affiliation(s)
- Claudia L Nau
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | | | | | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Benjamin Hong
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Ariadna Padilla
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Rebecca K Butler
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Aiyu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Heidi C Waters
- Global Value & Real World Evidence, Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, New Jersey
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7
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Abstract
Bipolar disorders (BDs) are recurrent and sometimes chronic disorders of mood that affect around 2% of the world's population and encompass a spectrum between severe elevated and excitable mood states (mania) to the dysphoria, low energy, and despondency of depressive episodes. The illness commonly starts in young adults and is a leading cause of disability and premature mortality. The clinical manifestations of bipolar disorder can be markedly varied between and within individuals across their lifespan. Early diagnosis is challenging and misdiagnoses are frequent, potentially resulting in missed early intervention and increasing the risk of iatrogenic harm. Over 15 approved treatments exist for the various phases of bipolar disorder, but outcomes are often suboptimal owing to insufficient efficacy, side effects, or lack of availability. Lithium, the first approved treatment for bipolar disorder, continues to be the most effective drug overall, although full remission is only seen in a subset of patients. Newer atypical antipsychotics are increasingly being found to be effective in the treatment of bipolar depression; however, their long term tolerability and safety are uncertain. For many with bipolar disorder, combination therapy and adjunctive psychotherapy might be necessary to treat symptoms across different phases of illness. Several classes of medications exist for treating bipolar disorder but predicting which medication is likely to be most effective or tolerable is not yet possible. As pathophysiological insights into the causes of bipolar disorders are revealed, a new era of targeted treatments aimed at causal mechanisms, be they pharmacological or psychosocial, will hopefully be developed. For the time being, however, clinical judgment, shared decision making, and empirical follow-up remain essential elements of clinical care. This review provides an overview of the clinical features, diagnostic subtypes, and major treatment modalities available to treat people with bipolar disorder, highlighting recent advances and ongoing therapeutic challenges.
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Affiliation(s)
- Fernando S Goes
- Precision Medicine Center of Excellence in Mood Disorders, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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8
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Henriques-Calado J, Pires R, Paulino M, Gama Marques J, Gonçalves B. Psychotic spectrum features in borderline and bipolar disorders within the scope of the DSM-5 section III personality traits: a case control study. Borderline Personal Disord Emot Dysregul 2023; 10:2. [PMID: 36647173 PMCID: PMC9841700 DOI: 10.1186/s40479-022-00205-w] [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: 08/18/2022] [Accepted: 11/14/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Psychotic spectrum features in borderline personality disorder (PD) are a long-standing phenomenon, but remarkably, to date, they have not been the focus of many empirical studies. Moreover, the comparative studies that acknowledge their links to affective psychoses are even more scarce. Likewise, the contributions of empirical research on the DSM-5 dimensional approach to this topic are also uncommon. This study seeks to identify the best set of pathological personality traits and/or symptoms that are predictors of psychotic features (psychoticism and ideation paranoid symptoms) in borderline PD and in bipolar disorder, based on the framework of the DSM-5 section III personality traits. METHODS A cross-sectional study of two clinical samples: 1) Borderline PD group of 63 participants; 2) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5 (PID-5); Brief Symptom Inventory (BSI). A series of linear and logistic regression analyses were computed. RESULTS Overall, the data emerging as common predictors are detachment, negative affectivity, psychoticism, depressivity, grandiosity, suspiciousness and interpersonal sensitivity symptoms. Borderline PD has the highest score in BSI paranoid ideation which emerges as its discriminating trait (Nagelkerke R2 = .58): cognitive and perceptual dysregulation (OR: 13.02), restricted affectivity (OR: 12.09), withdrawal (OR: 11.70), anhedonia (OR: 10.98) and emotional lability (OR: 6.69). CONCLUSIONS Besides the commonality that appears to overlap both disorders with a psychosis superspectrum, the patterns of the pathological personality-symptoms underlying the psychotic features appear to reinforce a position between schizophrenia and bipolar disorders that borderline PD may occupy, highlighting the possibility of its intersection with schizoaffective/psychosis spectra. The pathological personality nature of the psychotic features emerges as a potential comprehensive trait of the phenomenological dimensions.
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Affiliation(s)
- Joana Henriques-Calado
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal. .,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.
| | - Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal
| | - Marco Paulino
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - João Gama Marques
- Clínica Universitária de Psiquiatra e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisboa, Portugal.,Consulta de Esquizofrenia Resistente, Hospital Júlio de Matos, Centro Hospitalar Psiquiátrico de Lisboa, Avenida do Brasil, 53, 1749-002, Lisboa, Portugal
| | - Bruno Gonçalves
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, 1649-013, Lisboa, Portugal
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9
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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.
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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
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10
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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.
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Affiliation(s)
- Marta Elliott
- Department of Sociology, University of Nevada, Reno, NV, USA.
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11
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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.
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Affiliation(s)
- Adam Bayes
- Black Dog Institute, University of New South Wales (UNSW) Sydney, 2031, Australia.
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12
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Hasty MK, Macneil CA, Cotton SM, Berk M, Kader L, Ratheesh A, Ramain J, Chanen AM, Conus P. Personality disorder among youth with first episode psychotic mania: An important target for specific treatment? Early Interv Psychiatry 2022; 16:256-263. [PMID: 33768702 DOI: 10.1111/eip.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 12/01/2022]
Abstract
AIM Personality disorder is a common co-occurrence ('comorbidity') among patients with bipolar disorder and appears to affect outcome negatively. However, there is little knowledge about the impact of this comorbidity in the early phases of bipolar disorder. We examined the prevalence and effect of personality disorder co-occurrence on outcome in a cohort of youth with first episode mania with psychotic features. METHODS Seventy-one first episode mania patients, aged 15-29, were assessed at baseline, 6, 12, and 18 months as part of a randomized controlled trial of olanzapine and chlorpromazine as add-on to lithium in first episode mania with psychotic features. The current study involved secondary analysis of trial data. RESULTS A co-occurring clinical personality disorder diagnosis was present in 16.9% of patients. Antisocial and narcissistic personality disorders were the most common diagnoses. Patients with co-occurring personality disorder had higher rates of readmission to hospital, lower rates of symptomatic recovery and poorer functional levels at 6 months, but these differences disappeared after 12 and 18 months. CONCLUSIONS In the early phase of bipolar disorder, patients with personality disorder comorbidity display delayed symptomatic and functional recovery and increased likelihood to need hospital readmissions. These observations suggest that routine assessment for personality disorder and specific interventions are important in order to improve short-term treatment efficacy in this subgroup.
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Affiliation(s)
| | | | - Sue M Cotton
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Berk
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Deakin University, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia.,Department of Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Aswin Ratheesh
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Ramain
- Department of Psychiatry CHUV, Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Lausanne University, Lausanne, Switzerland
| | - Andrew M Chanen
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Philippe Conus
- Orygen, Melbourne, Victoria, Australia.,Department of Psychiatry CHUV, Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Lausanne University, Lausanne, Switzerland
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13
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Tondo L, Vázquez GH, Baldessarini RJ. Prevention of suicidal behavior in bipolar disorder. Bipolar Disord 2021; 23:14-23. [PMID: 33037692 DOI: 10.1111/bdi.13017] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/27/2020] [Accepted: 10/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Excess mortality is a critical hallmark of bipolar disorder (BD) due to co-occurring general medical disorders and especially from suicide. It is timely to review of the status of suicide in BD and to consider the possibility of limiting suicidal risk. METHODS We carried out a semi-systematic review of recent research reports pertaining to suicide in BD. FINDINGS Suicide risk in BD is greater than with most other psychiatric disorders. Suicide rates (per 100,000/year) are approximately 11 and 4 in the adult and juvenile general populations, but over 200 in adults, and 100 among juveniles diagnosed with BD. Suicide attempt rates with BD are at least 20 times higher than in the adult general population, and over 50 times higher among juveniles. Notable suicidal risk factors in BD include: previous suicidal acts, depression, mixed-agitated-dysphoric moods, rapid mood-shifts, impulsivity, and co-occurring substance abuse. Suicide-preventing therapeutics for BD remain severely underdeveloped. Evidence favoring lithium treatment is stronger than for other measures, although encouraging findings are emerging for other treatments. CONCLUSIONS Suicide is a leading clinical challenge for those caring for BD patients. Improved understanding of risk and protective factors combined with knowledge and close follow-up of BD patients should limit suicidal risk. Ethically appropriate and scientifically sound studies of plausible medicinal, physical, and psychosocial treatments aimed at suicide prevention specifically for BD patients are urgently needed.
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Affiliation(s)
- Leonardo Tondo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA
- Lucio Bini Mood Disorder Centers, Cagliari and Rome, Italy
| | - Gustavo H Vázquez
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Ontario, Canada
| | - Ross J Baldessarini
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- International Consortium for Mood & Psychotic Disorder Research, McLean Hospital, Belmont, MA, USA
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14
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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
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