Acute treatment outcomes in patients with bipolar I disorder and co‐morbid borderline personality disorder receiving medication and psychotherapy

Mar 15, 2005Bipolar disorders

Short-term treatment results in bipolar I patients with borderline personality receiving medication and therapy

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Abstract

Only 25% of patients with both bipolar I disorder and borderline personality disorder achieved stabilization compared to 74% of those with bipolar I disorder alone.

Patients with both disorders had a significantly longer median time-to-stabilization of 95 weeks, versus 35 weeks for bipolar-only patients.
The bipolar-BPD group required significantly more atypical mood-stabilizing medications per year.
High dropout rates were observed in patients with both conditions.
Some patients showed substantial improvement with the combined pharmacotherapy and psychotherapy approach.

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OBJECTIVE: Patients suffering from both bipolar I disorder and borderline personality disorder (BPD) pose unique treatment challenges. The purpose of this matched case-control study was to compare acute treatment outcomes of a sample of patients who met standardized diagnostic criteria for both bipolar I disorder and BPD (n = 12) to those who met criteria for bipolar I disorder only (n = 58).

METHOD: Subjects meeting criteria for an acute affective episode were treated with a combination of algorithm-driven pharmacotherapy and weekly psychotherapy until stabilization (defined as four consecutive weeks with a calculated average of the 17-item version of the Hamilton Rating Scale for Depression and Bech-Rafaelsen Mania scale totaling < or = 7).

RESULTS: Only three of 12 (25%) bipolar-BPD patients achieved stabilization, compared with 43 of 58 (74%) bipolar-only patients. Two of the three bipolar-BPD patients who did stabilize took over 95 weeks to do so, compared with a median time-to-stabilization of 35 weeks in the bipolar-only group. The bipolar-BPD group received significantly more atypical mood-stabilizing medications per year than the bipolar-only group (Z = 4.3, p < 0.0001). Dropout rates in the comorbid group were high.

CONCLUSIONS: This quasi-experimental study suggests that treatment course may be longer in patients suffering from both bipolar I disorder and BPD. Some patients improved substantially with pharmacotherapy and psychotherapy, suggesting that this approach is worthy of further investigation.

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Acute treatment outcomes in patients with bipolar I disorder and co‐morbid borderline personality disorder receiving medication and psychotherapy

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