Comparison of the Patient Groups With and Without Dissociative Disorder Comorbidity Among the Inpatients with Bipolar Disorder

Abstract

Introduction: This study aims to compare sociodemographic characteristics of the patients with bipolar disorder (BD) with and without comorbid dissociative disorder (DD) and to investigate the eventual effect of the comorbidity on the treatment. Methods:We enrolled a total of 149 patients diagnosed with BD and treated as inpatients consecutively in Şişli Etfal Hospital, Psychiatry Clinic between 2010 and 2011. For the patients who were diagnosed with DD using SCID-D and with BD using SCID-I, sociodemographic characteristics, YMRS, HAM-D, BPRS, DES scores and duration and number of hospital stays were evaluated. Results: 23 patients (15.4%) had dissociative disorder not otherwise specified (DD-NOS), 4 patients (2.6%) had dissociative identity disorder (DID) and 1 patient (0.6%) had dissociative amnesia. BD patients with comorbid DD were found to be predominantly female (p=0.015) and younger (p=0.002) and to have significantly higher DES scores than BD patients without DD (p<0.001). The total score of DES was correlated with duration hospital stay (p=0.001, Spearman r=0.336) in the total sample. Total HAM-D score at the time of admission was significantly higher in the comorbidity group (p=0.027), and suicide item was found to be significantly higher both at admission and at discharge (p<0.001 and p=0.035). Among BPRS scores at admission, hallucinatory behavior item was found to be higher in the comorbidity group (p=0.019). Among YMRS scores both at admission and at discharge, velocity and amount of speech item (p=0.027) and insight item at admission (p=0.006) was found to be significantly higher in the pure bipolar group (p=0.018). Conclusion:In patients with BD, DD comorbidity should be investigated. The BD patients with DD comorbidity tend to be female and younger, and show higher depression scores, leading to a prolonged hospital stay. In the presence of dissociation comorbidity, attempts and number of suicides and hallucinatory behaviors seem to be increased.

Investigation of the comorbidity of dissociative disorders in patients with bipolar disorder

“…Spitzer et al [32] have demonstrated lower treatment responses in bipolar patients with high dissociation scores. Bakım et al [33] have found the relationship between higher DES scores and duration hospital stay in patients with bipolar disorder. In our study, we found the age of disorder onset to be earlier and number of suicide attempts to be higher in bipolar patients with high dissociation scores.…”

Assessment of bipolar and psychological trauma spectrum disorders.

“…Individuals can have BSDs comorbid with DD (Bakim et al, 2016;Tekin et al, 2013). Patients with comorbid DD and bipolar disorders have more severe pathology, as indicated by longer hospitalizations, earlier onset of illness, and more suicide attempts (Bakim et al, 2016;Tekin et al, 2013).…”

“…Individuals can have BSDs comorbid with DD (Bakim et al, 2016;Tekin et al, 2013). Patients with comorbid DD and bipolar disorders have more severe pathology, as indicated by longer hospitalizations, earlier onset of illness, and more suicide attempts (Bakim et al, 2016;Tekin et al, 2013). Such individuals are prone to becoming manic when their sleep is disrupted for an extended period, and the mood instability due to bipolar disorders can be stabilized with mood stabilizers and antipsychotics.…”