The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.
Acute treatment outcomes in patients with bipolar I disorder and co-morbid borderline personality disorder receiving medication and psychotherapy
Version of Record online: 11 MAR 2005
Volume 7, Issue 2, pages 192–197, April 2005
How to Cite
Swartz, H. A., Pilkonis, P. A., Frank, E., Proietti, J. M. and Scott, J. (2005), Acute treatment outcomes in patients with bipolar I disorder and co-morbid borderline personality disorder receiving medication and psychotherapy. Bipolar Disorders, 7: 192–197. doi: 10.1111/j.1399-5618.2005.00179.x
- Issue online: 11 MAR 2005
- Version of Record online: 11 MAR 2005
- Received 5 February 2004, revised and accepted for publication 18 October 2004
- acute treatment;
- bipolar disorder;
- borderline personality disorder;
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 ≤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.