psychiatryRounds

Connecting Psychiatry - Expert community for all mental health professionals

Borderline Personality Disorder and Bipolar Disorder—Distinguishing Features of Clinical Diagnosis and Treatment

(PSYCHIATRIC TIMES) - Psychiatric Times - Category 1 Credit

To earn AMA PRA Category 1 Credit(s)™:
Read the article "Borderline Personality Disorder and Bipolar Disorder" from the July 2009 issue of Psychiatric Times, complete the posttest and the evaluation. (Note: A score of at least 70% must be achieved in order to be awarded credit.)

The posttest will be scored instantly and results will be shown onscreen. Please make a copy of your test results for your continuing education records. After submitting the activity evaluation, you may then print a Statement of Credit for your records.

You must keep your own records of this activity. Copy this information and include it in your continuing education file for reporting purposes.

CME LLC is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

CME LLC designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

CME LLC is approved by the California Board of Registered Nursing, Provider No. CEP12748, and designates this educational activity for 1.5 contact hours for nurses.

The American Nurses Credentialing Center (ANCC) accepts AMA PRA Category 1 Credits™ toward recertification requirements.

The American Academy of Physician Assistants (AAPA) accepts AMA PRA Category 1 Credits™ from organizations accredited by the ACCME.

Educational Objectives

After reading this article, you will be familiar with:

• Ways to distinguish between borderline personality disorder and bipolar disorder
• Diagnoses based on mood episodes, impulsivity, and longitudinal course of borderline personality disorder and bipolar disorder
• Treatment implications - pharmacological and psychosocial interventions

Who will benefit from reading this article?
Psychiatrists, psychologists, primary care physicians, nurse practitioners, and other health care professionals. To determine whether this article meets the continuing education requirements of your specialty, please contact your state licensing and certification boards.

Since the inclusion of the borderline personality disorder (BPD) diagnosis in DSM, there have been multiple efforts to recast the disorder as part of an Axis I illness category. While the initial focus was on the schizophrenia spectrum,1 more recent authors have attempted to link BPD to mood disorders. There is considerable literature on the relationship between major depressive disorder (MDD) and BPD, and although the current understanding posits distinct disorders, overlapping biological underpinnings do exist.2 Attention has now turned to bipolar disorder, with several vocal advocates who propose reclassifying BPD as bipolar spectrum disorder.3,4 This article discusses the overlapping phenomenology of bipolar disorder and BPD and highlights distinguishing features of clinical diagnosis and treatment.

Prevalence
According to DSM-IV-TR, the prevalence of BPD is estimated at 2% of the general population, compared with 1% to 2% for bipolar disorder. Other estimates are closer to 5% for bipolar spectrum disorder.5 Depending on the population studied, there are varying estimates of the co-occurrence of BPD and bipolar disorder. In a recent comprehensive review by Paris and colleagues,6 the rate of bipolar I disorder in BPD patients ranged from 5.6% to 16.1%, with a median of 9.2%. The rate of bipolar II disorder was only slightly higher, 8% to 19%, with a median of 10.7%. The 2 studies with the strongest methodologies that used structured diagnostic interviews with adequate sample sizes and a 6- to 7-year follow-up showed a low rate of new onset of bipolar disorder in patients with BPD, with no difference from the comparison groups.7,8 A recent study that used the large Collaborative Longitudinal Study of Personality Disorders (CLPS) database, however, showed an increased rate of bipolar I and II disorders in patients with BPD compared with patients who had personality disorders other than BPD, including schizotypal, avoidant, and obsessive-compulsive personality disorders (19.4% and 7.9%, respectively). In addition, BPD patients had a higher rate of bipolar I and II disorder onset (8.2% for BPD vs 3.1% for the other personality disorders) over 4 years.9 While these studies suggest a moderately increased risk for bipolar disorder in patients with BPD, it was not nearly as high as the risk for MDD or substance abuse.

For full article, please visit:
http://www.psychiatrictimes.com/dissociative-disorders/article/1016...

Views: 8

Comment

You need to be a member of psychiatryRounds to add comments!

Join psychiatryRounds


psychiatryRounds Social Media

Sponsors

CMEinfo: Board Reviews in Anesthesia, Cardiology, Internal Medicine, Radiology

© 2019   Created by PsychiatryRounds Team.   Powered by

Badges  |  Report an Issue  |  Terms of Service