Study results indicate that bipolar disorder (BD) may occur in up to half of individuals with co-existing borderline personality disorder (BPD) and depression.
Indeed, among a group of 5635 adults experiencing a current major depressive episode (MDE), BD was diagnosed in 48.8% of those with BPD (n=532).
However, BD occurred at a significantly lower rate of 29.7% among individuals without BPD (n=5103).
These findings, say Giulio Perugi (Clinica Psichiatrica Università Di Pisa, Italy) and co-authors, suggest that there is a need for physicians to assess patients with MDE and prominent borderline features for the presence of BD.
They add: "Correct identification of bipolarity in personality-disordered patients opens up the possibility that many BPD patients may benefit from pharmacological and psychological interventions that are of known benefit in BD."
The multinational study was conducted across 18 countries in Europe, Asia, and North Africa, and involved patients aged at least 18 years.
BD was defined according to DSM-IV-Text Revision, modified DSM-IV (without the use of the exclusion criteria included in DSM-IV- Text Revision) and bipolarity specifier criteria.
Of note, bipolarity specifier defines BD as an episode of elevated mood, an episode of irritable mood, or an episode of increased activity in the presence of at least three DSM-IV- Text Revision criteria.
Writing in Acta Psychiatrica Scandinavica, Perugi and colleagues say that the higher BD rate seen among patients with BPD than without BPD persisted, irrespective of the definition used for BD diagnosis.
Furthermore, BPD patients were younger than BPD-free patients and had higher rates of coexistent psychiatric conditions, such as psychotic symptoms, history of suicide, mixed states, and antidepressant-induced switch from depression to hypomania.
The authors say that the latter observation implies that BPD patients who present with MDE may not be suitable for antidepressant use as this may trigger a hypomanic episode.
However, they emphasize that further research is needed to confirm this hypothesis.
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