Bipolar Disorder and Comorbid Borderline Personality Disorder: Patient Characteristics and Outcomes in US Hospitals

Abstract

Background and objectives: The quality of life and disease outcomes in bipolar patients, including increased risk of psychiatric hospitalizations and suicide, are adversely affected by the presence of borderline personality disorder (BPD). Our study aims to determine the impact of BPD on the inpatient outcomes of bipolar disorder patients. Methods: We used Nationwide Inpatient Sample from the US hospitals and identified cases with bipolar disorder and comorbid BPD (N = 268,232) and controls with bipolar disorder only (N = 242,379), using the International Classification of Diseases, 9th Revision, and Clinical Modification codes. We used multinomial logistic regression to generate odds ratios (OR) and evaluate inpatient outcomes. Results: The majority of the bipolar patients with BPD were female (84.2%), Caucasian (83.1%) and 18–35 years age (53.9%). Significantly longer inpatient stays, higher inpatient charges, and higher prevalence of drug abuse were noted in bipolar patients with BPD. The suicide risk was higher in bipolar patients with BPD (OR = 1.418; 95% CI 1.384–1.454; p < 0.001). In addition, utilization of electroconvulsive treatment (ECT) was higher in bipolar patients with comorbid BPD (OR = 1.442; 95% CI 1.373–1.515; p < 0.001). Conclusions: The presence of comorbid BPD in bipolar disorder is associated with higher acute inpatient care due to a longer inpatient stay and higher cost during hospitalization, and higher suicide risk, and utilization of ECT. Further studies in the inpatient setting are warranted to develop effective clinical strategies for optimal outcomes and reduction of suicide risk in bipolar patients with BPD.

Medical and Psychiatric Comorbidities in Bipolar Disorder: Insights from National Inpatient Population-based Study

“…Females have about 1.6 times higher risk for anxiety and BPD compared to males [11]. About half of the BD patients with comorbid BPD are young adults (18-35 years), and they are at higher needs for acute inpatient care due to suicidal risk [26].…”

Does the comorbidity of borderline personality disorder affect the response to treatment in bipolar patients?

“…Finally, in a large sample retrospective study, Patel and collaborators found that ECT was more frequently administered in bipolar patients with BPD comorbidity than in those without BPD ( P > 0.001). In particular, the parameters evaluated were suicidal ideation, the duration of hospitalization, and the presence of comorbidities that worsen the prognosis, such as substance abuse (Patel et al ., 2019).…”

“…Globally, the selected studies indicate that the presence of comorbidity may hamper the effectiveness of treatment in BD in terms of longer hospitalization (Swartz et al ., 2005; Patel et al ., 2019), the administration of a second-line pharmacotherapy and ECT, or diminished improvement of symptoms such as hostility (Aguglia et al ., 2018). Of note, these trials assessed the effectiveness of atypical antipsychotics alone or in combination (Martínez and Caballero, 2017; Aguglia et al ., 2018; Garza Guerra et al ., 2022).…”

Lithium and Valproate in Bipolar Disorder: From International Evidence-based Guidelines to Clinical Predictors

“…Many variables predict recurrence of illness or poor outcome independent of treatment and may not be crucial in the choice of medication: history of previous episodes, subsyndromal or residual symptoms [ 12 , 25 , 101 , 102 ], alcoholism/substance use [ 12 , 91 ], anxiety [ 12 , 103 ], psychotic features [ 12 , 104 - 106 ], early onset of illness, [ 107 ], mixed features [ 108 - 110 ], rapid cycling course [ 12 , 111 , 112 ], personality comorbidity [ 12 , 113 ].…”