Posted by Phillipa on March 31, 2010, at 21:30:29
Seems if mania or hypomania doesn't last at least a week it's borderline personality. States no meds for borderline but for bipolar. Somehow I disagree. Phillipa
From Medscape Medical News
Borderline Personality, Bipolar Disorder Equally Likely for Positive MDQ Screens
Pam Harrison2010 Patients who score positive on the Mood Disorder Questionnaire (MDQ), the most widely used screening scale for bipolar disorder, are just as likely to be diagnosed as having borderline personality disorder as bipolar disorder, according to a study published online March 23 in the Journal of Clinical Psychiatry.
Mark Zimmerman, MD, Rhode Island Hospital and the Warren Alpert Medical School of Brown University in Providence, and colleagues found that of the 98 patients who screened positive on the MDQ, 23.5% were ultimately diagnosed as having bipolar disorder and 27.6% as having borderline personality disorder.
Results also showed that borderline personality disorder was 4 times more frequently diagnosed in patients with positive MDQ results at 21.5% than among patients who scored negative on the same test at 4.1% (P < .001).
Results were "essentially the same" when the analysis was restricted to the 188 patients with a current diagnosis of major depressive disorder at 27.6% for positive MDQ results vs 6.9% for negative MDQ results (P = .0001).
"There are no medications that have been proven effective for the treatment of borderline personality disorder, whereas there are clearly effective treatments for bipolar disorder," Dr. Zimmerman told Medscape Psychiatry.
"So its vital that we develop or identify a more accurate method to distinguish between these 2 conditions and adopt it into clinical practice."
Psychiatric Outpatients
For the study, 534 psychiatric outpatients were interviewed by a highly trained diagnostic rater who administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) and the Structured Interview for DSM-IV Personality Disorders. Subjects were also asked to complete the MDQ. The MDQ screens for a lifetime history or mania or hypomania with 13 yes/no symptom questions reflecting the DSM-IV inclusion criteria.
"Missing data on the MDQ reduced the sample size to 480," the investigators note, whereas approximately 10% of the sample was diagnosed as having a lifetime history of bipolar disorder and were excluded from the initial analyses. The analysis was performed on 428 patients without a lifetime history of bipolar disorder, 65 (15.2%) of whom screened positive on the MDQ.
Its vital that we develop or identify a more accurate method to distinguish between these 2 conditions.
As the study authors note, there was a 5- to 6-fold increase in the frequency of borderline personality disorder in the group with positive MDQ results compared with the group with negative MDQ results. Indeed, "in the present study, we found that among patients who screened positive on the MDQ, as many patients were diagnosed with borderline personality disorder as were diagnosed with bipolar disorder."The nonspecificity of this screening tool is "not surprising," they add, given that both disorders share many common features. At the same time, the inability of the MDQ to adequately distinguish between borderline personality disorder and bipolar disease becomes clinically important when it comes to treatment.
"We are seeing too many patients who, on the basis of minimal information, are given the diagnosis of bipolar disorder," Dr. Zimmerman said, "and I think we simply need to pay attention to the diagnoses we make, and we should not be making diagnoses for individuals who do not meet the diagnostic criteria for the disorder."
MDQ Scale "Completely Invalid"
Joel Paris, MD, McGill University, Montreal, Quebec, Canada, agreed with Dr. Zimmerman and colleagues, saying that the MDQ scale is "completely invalid." As he told Medscape Psychiatry, "the scale lists all the symptoms of bipolar disorder, but it does not attach any time scale."
So, for example, a patient who is experiencing a manic or hypomanic episode will be in that episode for days or even weeks at a time. In contrast, patients with borderline personality disorder typically have several mood swings in the course of a single day.
"If the scale had asked patients, have you ever been like this for 1 week at a time without any breaks, then it might be a better screen for bipolar disorder, but it doesn't say that," Dr. Paris noted, "and physicians need to remember that a hypomanic episode is a minimum of 4 days of continuous abnormal mood."
Dr. Zimmerman and Dr. Paris have disclosed no relevant financial relationships.
J Clin Psychiatry. Published online March 23, 2010.
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