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Acute treatment outcomes in patients with bipolar I disorder and co‐morbid borderline personality disorder receiving medication and psychotherapy
Author(s) -
Swartz Holly A,
Pilkonis Paul A,
Frank Ellen,
Proietti Joseph M,
Scott John
Publication year - 2005
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/j.1399-5618.2005.00179.x
Subject(s) - borderline personality disorder , bipolar disorder , mania , young mania rating scale , pharmacotherapy , psychology , mood , psychiatry , bipolar i disorder , bipolar ii disorder , clinical psychology , depression (economics) , medicine , economics , macroeconomics
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.