Borderline personality disorder ‘not linked to psychosis transition’

By Mark Cowen, Senior MedWire Reporter

The presence of borderline personality disorder (BPD) is not associated with an increased risk for transition to full-blown psychosis in ultra-high risk (UHR) patients, research shows.

The authors found that there was no significant difference in 24-month psychotic outcomes between UHR patients with and without BPD.

"Clinicians working in UHR clinics have often seen Axis II features as co-morbidity, rather than risk or protective factors per se. This is in contrast to Axis I disorders, such as depression, that have often been implicated in increasing the risk for transition to psychosis in the UHR group," comment Andrew Thompson (Centre for Youth Mental Health, Parkville, Victoria, Australia) and team.

"Our findings support this distinction but we do not suggest that BPD pathology should be ignored as a clinical problem in its own right," they add.

The researchers studied 96 patients deemed to be at UHR for psychosis due to the presence of attenuated psychotic symptoms within the previous 12 months, a history of brief self-limited psychotic symptoms in the previous 12 months, or a genetic vulnerability to psychotic disorder with either schizotypal personality disorder or family history of psychotic disorder in a first-degree relative.

Of these, 48 developed full-blown psychosis over a follow-up period of 24 months, with no significant difference among the groups regarding at-risk criteria met, or functioning level at baseline.

Overall, 14.6% of the participants met DSM-IV criteria for BPD at baseline.

The researchers found that there was no significant difference between patients who did and did not develop full-blown psychosis regarding the presence of baseline BPD rates.

There were also no significant differences between the groups regarding the number of BPD traits.

"It appears that UHR patients with concurrent BPD pathology experience similar psychotic outcomes to those without BPD pathology, at least over the short term," conclude Thompson and team.

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