Apfelbaum Sergio, Regalado Pilar, Herman Laura, Teitelbaum Julia, Gagliesi Pablo
Casa de Familia Córdoba, Argentina.
Actas Esp Psiquiatr. 2013 Sep-Oct;41(5):269-78. Epub 2013 Sep 1.
Several lines of evidence have well established a relationship between Bipolar Disorder and Cluster B Personality Disorders. The study compares mood spectrum and temperamental symptoms, personality traits and clinical characteristics among outpatients (n = 63) diagnosed with major depression (MD), bipolar disorder (BD), cluster B personality disorders (PD-B) and comorbidity of BD + PD-B.
The diagnosis was determined with structured interviews (MINI and SCID II) and symptom assessments with evaluation and diagnostic instruments (MOODS-SR, BI, TEMPS-A and IPDE). Differences between groups were explored with post hoc analysis and analysis of variance.
Patients with BD+PD-B comorbidity presented an earlier onset and more severity in suicide attempts, hospitalizations and self-harm behaviors. They showed more characteristics of cyclothymic and irritable temperament and more cluster A and B personality traits, than patients with BD only. PD-B patients obtained intermediate scores in manic like symptoms: higher than patients with depression and lower than patients with bipolar disorder. However, the Bipolarity Index clearly distinguished patients with BD or with comorbidity (BD+PD-B) from the other diagnostic groups (PD-B and MD).
BD+PD-B comorbidity presents a more severe type of emotional dysregulation compared to the other diagnostic groups, including BD and PD-B alone. Assessing temperament, personality traits, emotional dysregulation in mania and depression, self-harm and hospitalizations severity and age onset could facilitate differential diagnosis and enhance effectiveness of treatments for BD, PD-B and their comorbidity.
多条证据充分证实了双相情感障碍与B类人格障碍之间的关系。本研究比较了被诊断为重度抑郁症（MD）、双相情感障碍（BD）、B类人格障碍（PD - B）以及双相情感障碍合并B类人格障碍（BD + PD - B）的门诊患者（n = 63）的情绪谱、气质性症状、人格特质和临床特征。
通过结构化访谈（MINI和SCID II）进行诊断，并用评估和诊断工具（MOODS - SR、BI、TEMPS - A和IPDE）进行症状评估。采用事后分析和方差分析探讨组间差异。
双相情感障碍合并B类人格障碍（BD + PD - B）的患者在自杀企图、住院治疗和自我伤害行为方面发病更早且更为严重。与仅患有双相情感障碍的患者相比，他们表现出更多的环性心境气质和易激惹气质特征，以及更多的A类和B类人格特质。B类人格障碍（PD - B）患者在躁狂样症状方面得分居中：高于抑郁症患者，低于双相情感障碍患者。然而，双相性指数能明确区分双相情感障碍患者或合并症患者（BD + PD - B）与其他诊断组（PD - B和MD）。
与其他诊断组相比，包括单独的双相情感障碍和B类人格障碍，双相情感障碍合并B类人格障碍（BD + PD - B）呈现出更严重的情绪调节障碍类型。评估气质、人格特质、躁狂和抑郁中的情绪调节障碍、自我伤害以及住院治疗的严重程度和发病年龄，有助于进行鉴别诊断并提高双相情感障碍、B类人格障碍及其合并症的治疗效果。
