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Twelve-month outcome in bipolar patients with and without personality disorders
E Dunayevich1, K W Sax, P E Keck
1Clinical Psychobiology Program, Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559, USA.
Background:
We studied the 12-month course of illness after hospitalization for patients with a DSM-III-R diagnosis of bipolar disorder, manic or mixed episode, to identify the impact of a co-occurring personality disorder on measures of outcome.
Method:
Fifty-nine patients with bipolar disorder hospitalized for the treatment of a manic or mixed episode were recruited. Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization. Personality disorders were assessed using the Structured Clinical Interview for DSM-III-R, personality disorders version (SCID-II). Patients were then reevaluated at 2, 6, and 12 months after discharge to assess syndromic, symptomatic, and functional recovery. Factors associated with outcome were identified using multivariate analyses.
Results:
Survival analyses showed that in the 12-month follow-up period, subjects with bipolar disorder and co-occurring personality disorder were significantly less likely to achieve recovery. Logistic regression analyses indicated that both a diagnosis of personality disorder and noncompliance with treatment were significantly associated with lack of syndromic recovery.
Conclusion:
Co-occurring personality disorders in patients with bipolar disorder are associated with poor outcome after hospitalization for mania.