Relationships between mixed features and borderline personality disorder in 2811 patients with major depressive episode

Perugi, Giulio; Angst, Jules; Azorin, Jean‐Michel; Bowden, Charles L.; Caciagli, A.; Sn, Mosolov; Vieta, Eduard; Young, Allan H.

doi:10.1111/acps.12457

Cited by 31 publications

(28 citation statements)

References 79 publications

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“…Interestingly, these results are in contrast to those of an earlier study reporting that patients with borderline personality disorder have a high prevalence of BD (Perugi et al, ). In this study, a cluster‐B personality disorder was more prevalent in patients with MDD than in those with BD.…”

Section: Discussioncontrasting

confidence: 99%

The prevalence and diagnostic classification of mixed features in patients with major depressive episodes: A multicenter study based on the DSM‐5

Shim

Lee

Kim

et al. 2019

Int J Methods Psych Res

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Objectives The purpose of this study was to evaluate the prevalence of mixed features using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) and to examine how patients with mixed states would be classified using the DSM‐5. Methods In total, 12 hospitals participated in this study, and data on the demographic characteristics and clinical diagnoses of patients treated between October 2013 and September 2016 were obtained. We reviewed the data for opposite‐polarity symptoms according to the DSM‐5 criteria and the research‐based diagnostic criteria. Results Of the 859 patients included in the final analysis, the prevalence of mixed features in patients with major depressive episodes based on the DSM‐5 remained low. Patients with major depressive disorder were more likely to be classified as experiencing anxious distress and/or a cluster‐B personality disorder in mixed state patients not diagnosed with DSM‐5 mixed features, whereas more mixed state patients with bipolar disorder were diagnosed with mixed features using the DSM‐5. Conclusions The prevalence of mixed features did not increase significantly when the DSM‐5 was used, and patients with mixed states were more likely to be classified as having anxious distress and/or a cluster‐B personality disorder in addition to mixed features.

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Section: Discussioncontrasting

confidence: 99%

The prevalence and diagnostic classification of mixed features in patients with major depressive episodes: A multicenter study based on the DSM‐5

Shim

Lee

Kim

et al. 2019

Int J Methods Psych Res

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“…The general methodology of the BRIDGE-II-MIX study was described in detail in previous reports (20)(21)(22)(23). The BRIDGE-II-Mix study was a multicenter, international, noninterventional, cross-sectional study.…”

Section: Sample and Assessmentmentioning

confidence: 99%

Aggressiveness in depression: a neglected symptom possibly associated with bipolarity and mixed features

Verdolini

Perugi

Samalin

et al. 2017

Acta Psychiatr Scand

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Objective: To evaluate aggressiveness during a major depressive episode (MDE) and its relationship with bipolar disorder (BD) in a post-hoc analysis of the BRIDGE-II-MIX study.Method: A total of 2,811 individuals were enrolled in this multicenter cross-sectional study. MDE patients with (MDE-A, n=399) and without aggressiveness (MDE-N, n=2,412) were compared through Chi-square test or Student's t-test. A stepwise backward logistic regression model was performed.Results: MDE-A group was more frequently associated with BD (p<0.001) whilst aggressiveness was negatively correlated with unipolar depression (p<0.001). At the logistic regression aggressiveness was associated with: the age at first depressive episode (p<0.001); the severity of mania (p=0.03); the diagnosis of BD (p=0.001); comorbid borderline personality disorder (BPD) (p<0.001) but not substance abuse (p=0.63); no current psychiatric treatment (p<0.001); psychotic symptoms (p=0.007); the marked social/occupational impairment (p=0.002). The variable most significantly associated with aggressiveness was the presence of DSM-5 mixed features (p<0.001, OR=3.815). After the exclusion of BPD, the variable of lifetime suicide attempts became significant (p=0.013, OR=1.405). Conclusion:Aggressiveness seems to be significantly associated with bipolar spectrum disorders, independently from BPD and substance abuse. Aggressiveness should be considered as a diagnostic criterion for the mixed features specifier and a target of tailored treatment strategy.Keys words: aggressiveness, bipolar disorder, DSM-5 mixed features specifier, major depressive episode 3 Significant outcomesIn this post-hoc analysis of the BRIDGE-II-MIX study, the presence of aggressive behaviors was mainly related with socio-demographic and clinical characteristics associated with bipolarity.

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“…The objective of the Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)‐II‐Mix naturalistic study was to provide a reliable estimate of the frequency of mixed states in a large international sample of patients diagnosed with an MDE according to several sets of criteria.…”

Section: Introductionmentioning

confidence: 99%

Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study

et al. 2017

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Objectives: BRIDGE-II-MIX study aimed to estimate the frequency of mixed states in patients with MDE according to different definitions. This post-hoc analysis evaluates the association between obesity and the presence of mixed features and bipolarity. Methods: 2811 MDE subjects were enrolled in this multicentre crosssectional study. In 2744 patients, the body mass index (BMI) has been evaluated.Psychiatric symptoms, socio-demographic and clinical variables were collected, comparing the characteristics of MDE patients with (MDE-OB) and without obesity (MDE-NOB). Results: obesity (BMI ≥30) was registered in 493 patients (18%). In the MDE-OB group, 90 patients (20%) fulfilled DSM-IV-TR criteria for BD, 225 patients (50%) fulfilled the criteria for bipolarity specifier, 59 patients (13%) fulfilled DSM-5 criteria for MDE with mixed features and 226 patients (50%) fulfilled Research-Based Diagnostic Criteria for a mixed depressive episode. Older age, history of (hypo)manic switches during antidepressant treatment, the occurrence of three or more MDEs, atypical depressive features, antipsychotic treatment, female gender, depressive mixed state according to DSM-5 criteria, comorbid eating disorders and anxiety disorders were significantly associated with MDE-OB group. Among (hypo)manic symptoms during the current MDE, psychomotor agitation, distractibility, increased energy and risky behaviors were the variables most frequently associated with MDE-OB group.Conclusions: In our sample, the presence of obesity in patients with MDE seems to be associated with a lifetime diagnosis of BD. These findings suggest that obesity in patients with MDE could be considered a possible marker of bipolarity.

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Relationships between mixed features and borderline personality disorder in 2811 patients with major depressive episode

Abstract: Major depressive episode patients with comorbid BPD reported a high prevalence of mixed features and BD. The presence of DSM-5 mixed features in MDE patients with BPD may be associated with complex course and reduced treatment response.

Cited by 31 publications

References 79 publications

The prevalence and diagnostic classification of mixed features in patients with major depressive episodes: A multicenter study based on the DSM‐5

The prevalence and diagnostic classification of mixed features in patients with major depressive episodes: A multicenter study based on the DSM‐5

Aggressiveness in depression: a neglected symptom possibly associated with bipolarity and mixed features

Obesity in patients with major depression is related to bipolarity and mixed features: evidence from the BRIDGE‐II‐Mix study

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