Abstract
BackgroundBipolar disorder (BD) and borderline personality disorder (BPD) both are severe and chronic psychiatric disorders. Both disorders have overlapping symptoms, and current research shows that the presence of a BPD has an adverse effect on the course of BD. The limited research available shows an unfavorable illness course, a worse prognosis and response to medication, longer treatment duration, more frequent psychiatric admissions, higher drop-out, increased risk of substance abuse, increased risk of suicide, and more impairment of social and occupational functioning. However, there is no research available on the effect of specific psychotherapeutic treatment for this patients.Methods/DesignThis paper presents the protocol of a RCT to investigate the presence of borderline personality features in patients treated for BD (study part 1) and the effectiveness of STEPPS (Systems Training for Emotional Predictability and Problem Solving) added to treatment as usual (TAU) for BD compared to TAU in patients with BD and comorbid borderline personality features (study part 2). STEPPS is a validated and effective intervention for BPD. The study population consists of patients treated for BD at specialized outpatient clinics for BD in the Netherlands. At first the prevalence of comorbid borderline personality features in outpatients with BD is investigated. Inclusion criteria for study part 2 is defined as having three or more of the DSM-IV-TR diagnostic criteria of BPD, including impulsivity and anger bursts. Primary outcomes will be the frequency and severity of manic and depressive recurrences as well as severity, course and burden of borderline personality features. Secondary outcomes will be quality of life, utilizing mental healthcare and psychopathologic symptoms not primarily related to BD or BPD. Assessment will be at baseline, at the end of the intervention, and at 12 and 18 months follow-up.DiscussionThis will be the first randomized controlled trial of a specific intervention in patients with BD and comorbid BPD or borderline personality features. There are no recommendations in the guideline of treatment of bipolar disorders for patients with this complex comorbidity. We expect that a combined treatment aimed at mood disorder and emotion regulation will improve treatment outcomes for these patients.
Highlights
Bipolar disorder (BD) and borderline personality disorder (BPD) both are severe and chronic psychiatric disorders
This study evaluates the addition of STEPPS (Systems Training for Emotional Predictability and Problem Solving) to treatment as usual (TAU) in patients with BD and comorbid BPD or borderline personality features as described in the inclusion criteria
Design Study part 1 Screening for personality disorder with a questionnaire (PDQ4+) in patients with BD treated in a specialized outpatient facility, followed by a semi-structured diagnostic interview (SCID-II) in those patients who screened positive on BPD or borderline personality features relevant for this study
Summary
Bipolar disorder (BD) and borderline personality disorder (BPD) both are severe and chronic psychiatric disorders Both disorders have overlapping symptoms, and current research shows that the presence of a BPD has an adverse effect on the course of BD. The limited research available shows an unfavorable illness course, a worse prognosis and response to medication, longer treatment duration, more frequent psychiatric admissions, higher drop-out, increased risk of substance abuse, increased risk of suicide, and more impairment of social and occupational functioning. There is evidence that the presence of comorbid PD has a negative impact on the course of BD, leading to more mixed episodes and depressive symptoms, a higher suicide risk, a worse therapeutic response, and less treatment adherence [13]. In a matched case–control study Swartz et al [16] compared patients who met diagnostic criteria for both BD and BPD with patients with
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