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Personality disorder comorbidity among patients with bipolar I disorder in remission

Published online by Cambridge University Press:  24 June 2014

Lut Tamam*
Affiliation:
Cukurova University Faculty of Medicine, Department of Psychiatry, Adana, Turkey
Nurgul Ozpoyraz
Affiliation:
Cukurova University Faculty of Medicine, Department of Psychiatry, Adana, Turkey
Gonca Karatas
Affiliation:
Cukurova University Faculty of Medicine, Department of Psychiatry, Adana, Turkey
*
Lut Tamam MD, Cukurova Universitesi Tip Fakultesi, Psikiyatri Anabilim Dali, 01330 Balcali, Adana, Turkey. Tel: 90-533-6306006; Fax: 90-322-3386505; E-mail: Ltamam@mail.cu.edu.tr

Abstract

Background:

Comorbid personality disorders have been shown to be a prominent factor affecting symptom severity and course in bipolar disorder (BD) patients. Bipolar patients with personality disorder had more relapses, poorer prognosis and worse treatment response than those without an axis II diagnosis.

Objective:

We evaluated the prevalence rate of comorbid personality disorder in 74 bipolar I disorder cases who were in remission and tried to elucidate the possible relationship between comorbid axis II disorders and prognosis, severity and treatment features of BD cases.

Methods:

Diagnosis of all personality disorder comorbidities was evaluated using the Structured Clinical Interview for DSM-III-R Axis-II Disorders (SCID-II), while the general psychopathology level was assessed using the Symptom Check List (SCL-90-R). A questionnaire for acquiring sociodemographic and clinical variables was also used.

Results:

Sixty-two per cent of bipolar I patients in this sample had at least one comorbid axis II disorder. The most common comorbid cluster of personality disorder was cluster C (48.6%), followed by cluster A (25.7%) and cluster B (20.3%) personality disorders. Assessment of demographic and clinical variables revealed that bipolar patients with comorbid personality disorder were mainly female, had multiple affective episodes, and had attempted suicide more often than patients without personality disorder.

Conclusions:

The results of this study suggest that comorbid personality disorder might alter the course of BD and result in a poorer prognosis and more severe psychopathology. Further prospective controlled studies minimizing the bias of interviewers and other confounding factors would help us to understand the pure impact of personality disorder on the course of BD, its prognosis and response to treatment.

Type
Original Article
Copyright
Copyright © 2004 Blackwell Munksgaard

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References

Barbato, N, Hafner, JR. Comorbidity of bipolar and personality disorder. Aust NZ J Psychiatry 1998;32: 276280. CrossRefGoogle ScholarPubMed
Charney, DS, Nelson, JC, Quinlan, DM. Personality traits and disorder in depression. Am J Psychiatry 1981;138: 16011604.Google ScholarPubMed
Rossi, A, Marinangeli, MG, Butti, Get al. Personality disorders in bipolar and depressive disorders. J Affect Disord 2001;65: 38.CrossRefGoogle ScholarPubMed
Oldham, JM, Skodol, AE, Kellman, HDet al. Comorbidity axis i axis ii disorders. Am J Psychiatry 1995;152: 571578.Google ScholarPubMed
Mezzich, JE, Ahn, CW, Fabrega, H, Pilkonis, PA. Patterns of psychiatric comorbidity in a large population presenting for care. In: Maser, JD, Cloninger, CR, eds. Comorbidity of Mood and Anxiety Disorders. Washington, DC: American Psychiatric Press, 1990. Google Scholar
O'Connell, RA, Mayo, JA, Sciutto, MS. PDQ-R personality disorders in bipolar patients. J Affect Disord 1991;23: 217221.CrossRefGoogle ScholarPubMed
Pica, S, Edwards, J, Jackson, HJ, Bell, RC, Bates, GW, Rudd, RP. Personality disorders in recent-onset bipolar disorder. Compr Psychiatry 1990;31: 499510.CrossRefGoogle ScholarPubMed
Maier, W, Minges, J, Lichtermann, D, Heun, R. Personality disorders and personality variations in relatives of patients with bipolar affective disorders. J Affect Disord 1995;53: 173181. CrossRefGoogle Scholar
Carpenter, D, Clarkin, JF, Glick, ID, Wilner, PJ. Personality pathology among married adults with bipolar disorder. J Affect Disord 1995;34: 269274.CrossRefGoogle ScholarPubMed
Dunayevich, E, Strakowski, SM, Sax, KWet al. Personality disorders in first- and multiple-episode mania. Psychiatry Res 1996;64: 6975.CrossRefGoogle ScholarPubMed
Dunayevich, E, Sax, KW, Keck, JRPEet al. Twelve-month outcome in bipolar patients with and without personality disorders. J Clin Psychiatry 2000;61: 134139.CrossRefGoogle ScholarPubMed
Kay, Jh, Altshuler, LL, Ventura, J, Mintz, J. Impact of axis II comorbidity on the course of bipolar illness in men: a retrospective chart review. Bipolar Disord 2002;4: 237242.CrossRefGoogle ScholarPubMed
Peselow, ED, Sanfilippo, MP, Fieve, RR. Relationship between hypomania and personality disorders before and after successful treatment. Am J Psychiatry 1995; 152: 232238.Google ScholarPubMed
Utan, AV, Syed, H. Borderline personality disorder and bipolar mood disorder: Two distinct disorders or a continuum. J Nerv Ment Dis 1999;187: 313315.Google Scholar
Vieta, E, Colom, F, Martinez-Aran, A, Benabarre, A, Gasto, C. Personality disorders in bipolar II patients. J Nerv Ment Dis 1999;187: 245248.CrossRefGoogle ScholarPubMed
Colom, F, Vieta, E, Martinez-Aran, A, Reinares, M, Benabarre, A, Gasto, C. Clinical factors associated with treatment noncompliance in euthymic bipolar patients. J Clin Psychiatry 2000;61: 549555.CrossRefGoogle ScholarPubMed
Takata, T, Takaoka, K. Bipolar II disorder and its premorbid personality. Psychopathology 2000;33: 8693.CrossRefGoogle ScholarPubMed
Solomon, DA, Shea, MT, Leon, ACet al. Personality traits in subjects with bipolar I disorder in remission. J Affect Disord 1996;40: 4148.CrossRefGoogle ScholarPubMed
Black, DW, Winokur, G, Bell, S, Nasrallah, A, Hullbert, J. Complicated mania: comorbidity and immediate outcome in the treatment of mania. Arch Gen Psychiatry 1988;45: 232236.CrossRefGoogle ScholarPubMed
Ucok, A, Karaveli, D, Kundakci, T, Yazici, O. Comorbidity of personality disorders with bipolar mood disorders. Compr Psychiatry 1998;39: 7274.CrossRefGoogle ScholarPubMed
Flick, SN, Roy-Bryne, PP, Cowley, DS, Shores, MM, Dunner, DL. DSM-III-R personality disorders in a mood and anxiety disorders clinic: prevalence, comorbidity, nad clinical correlates. J Affect Disord 1993; 27: 7179.CrossRefGoogle Scholar
Leverich, GS, Altshuler, LL, Mcelroy, SLet al. Prevalence of axis II comorbidity in bipolar disorder: relationship to mood state and course of illness. Acta Neuropsychiatrica 2000;12: 161162. Google Scholar
Spitzer, RL, Williams, JBW, Gibbon, M. Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). New York: Biometrics Research, 1987. Google Scholar
Derrogatis, LR. SCL-90-R: Administration, Scoring and Procedures. Baltimore: Clinical Psychometric Research, 1987. Google Scholar
Keller, MB, Lavorý, PW, Coryell, Wet al. Differential outcome of pure manic, mixed/cycling, and pure depressive episodes in patients with bipolar illness. J Am Med Assoc 1986;255: 33183342. CrossRefGoogle ScholarPubMed
Coryell, W, Scheftner, W, Keller, M, Endicott, J, Maser, J, Klerman, GL. The enduring psychosocial consequences of mania and depression. Am J Psychiatry 1993;150: 720727.Google ScholarPubMed