Longitudinal outcome in patients with bipolar disorder assessed by life-charting is influenced by DSM-IV personality disorder symptoms

• Published in: Bipolar disorders Vol. 5; no. 1; pp. 14 - 21
• Main Authors: Bieling, Peter J, MacQueen, Glenda M, Marriot, Michael J, Robb, Janine C, Begin, Helen, Joffe, Russell T, Young, L Trevor
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01-02-2003
• Subjects: Adult; bipolar disorder; Bipolar Disorder - drug therapy; Bipolar Disorder - epidemiology; Bipolar Disorder - pathology; Comorbidity; Data Collection; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; longitudinal outcome; Longitudinal Studies; Male; Middle Aged; personality disorder; personality disorder symptoms; Personality Disorders - drug therapy; Personality Disorders - epidemiology; Personality Disorders - pathology; Practice Guidelines as Topic; Treatment Outcome
• ISSN: 1398-5647; 1399-5618
• DOI: 10.1034/j.1399-5618.2003.00014.x

Objectives:  Few studies have examined the question of how personality features impact outcome in bipolar disorder (BD), though results from extant work and studies in major depressive disorder suggest that personality features are important in predicting outcome. The primary purpose of this paper was to examine the impact of DSM‐IV personality disorder symptoms on long‐term clinical outcome in BD.
Methods:  The study used a ‘life‐charting’ approach in which 87 BD patients were followed regularly and treated according to published guidelines. Outcome was determined by examining symptoms over the most recent year of follow‐up and personality symptoms were assessed with the Structured Clinical Interview for DSM‐IV (SCID‐II) instrument at entry into the life‐charting study.
Results:  Patients with better outcomes had fewer personality disorder symptoms in seven out of 10 disorder categories and Cluster A personality disorder symptoms best distinguished euthymic and symptomatic patients.
Conclusions:  These results raise important questions about the mechanisms linking personality pathology and outcome in BD, and argue that conceptual models concerning personality pathology and BD need to be further developed. Treatment implications of our results, such as need for psychosocial interventions and treatment algorithms, are also described.