Twelve-month outcome in bipolar patients with and without personality disorders

Background: We studied the 12-month course of illness after hospitalization for patients with a DSM-III-R diagnosis of bipolar disorder, manic or mixe d episode, to identify the impact of a cooccurring personality disorder on measures of outcome. Method: Fifty-nine patients with bipolar disorder hospitalized for the trea tment of a manic or mixed episode were recruited. Diagnostic, symptomatic, and functional evaluations were obtained at the index hospitalization. Pers onality disorders were assessed using the Structured Clinical Interview for DSM-III-R, personality disorders version (SCID-II). Patients were then ree valuated at 2, 6, and 12 months after discharge to assess syndromic, sympto matic, and functional recovery. Factors associated with outcome were identi fied using multivariate analyses. Results: Survival analyses showed that in the 12-month follow-up period, su bjects with bipolar disorder and co-occurring personality disorder were sig nificantly less likely to achieve recovery. Logistic regression analyses in dicated that both a diagnosis of personality disorder and noncompliance wit h treatment were significantly associated with lack of syndromic recovery. Conclusion: Go-occurring personality disorders in patients with bipolar dis order are associated with poor outcome after hospitalization for mania.