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Medicina 2019, 55(1), 13; https://doi.org/10.3390/medicina55010013

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

1
Department of Psychiatry, Griffin Memorial Hospital, 900 E Main St, Norman, OK 73071, USA
2
Department of Psychiatry, Texas Tech University Health Science Center, Midland, TX 79701, USA
3
Department of Psychiatry, Allegheny Health Network, 4 Allegheny Center 8th Floor, Pittsburgh, PA 15212, USA
*
Author to whom correspondence should be addressed.
Received: 2 November 2018 / Revised: 27 December 2018 / Accepted: 3 January 2019 / Published: 14 January 2019
PDF [270 KB, uploaded 14 January 2019]

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.
Keywords: bipolar disorder; borderline personality disorder; personality disorder; comorbidity; inpatient psychiatry; suicidal; management; hospital outcomes; mood disorder; manic episode bipolar disorder; borderline personality disorder; personality disorder; comorbidity; inpatient psychiatry; suicidal; management; hospital outcomes; mood disorder; manic episode
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Patel, R.S.; Manikkara, G.; Chopra, A. Bipolar Disorder and Comorbid Borderline Personality Disorder: Patient Characteristics and Outcomes in US Hospitals. Medicina 2019, 55, 13.

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