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Borderline Personality Features in Inpatients with Bipolar Disorder

Impact on Course and Machine Learning Model Use to Predict Rapid Readmission

SALEM, HAITHAM MD, PhD; RUIZ, ANA; HERNANDEZ, SARAH; WAHID, KAREEM MD, PhD; CAO, FEI MD, PhD; KARNES, BRANDI MD; BEASLEY, SARAH MD; SANCHES, MARSAL MD, PhD; ASHTARI, ELAHEH PSYD; PIGOTT, TERESA MD

Journal of Psychiatric Practice®: July 2019 - Volume 25 - Issue 4 - p 279–289
doi: 10.1097/PRA.0000000000000392
Winner of Resident Paper Award 2018
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Background: Earlier research indicated that nearly 20% of patients diagnosed with either bipolar disorder (BD) or borderline personality disorder (BPD) also met criteria for the other diagnosis. Yet limited data are available concerning the potential impact of co-occurring BPD and/or BPD features on the course or outcome in patients with BD. Therefore, this study examined this comorbidity utilizing the standardized Borderline Personality Questionnaire (BPQ).

Methods: This study involved 714 adult patients with a primary diagnosis of BD per DSM-IV criteria who were admitted to the psychiatric unit at an academic hospital in Houston, TX between July 2013 and July 2018. All patients completed the BPQ within 72 hours of admission. Statistical analysis was used to detect correlations between severity of BD, length of stay (LOS), and scores on the BPQ. A machine learning model was constructed to predict the parameters affecting patients’ readmission rates within 30 days.

Results: Analysis revealed that the severity of certain BPD traits at baseline was associated with mood state and outcome measured by LOS. Inpatients with BD who were admitted during acute depressive episodes had significantly higher mean scores on 7 of the 9 BPQ subscales (P<0.05) compared with those admitted during acute manic episodes. Inpatients with BD with greater BPQ scores on 4 of the 9 BPQ subscales had significantly shorter LOS than those with lower BPQ scores (P<0.05). The machine learning model identified 6 variables as predictors for likelihood of 30-day readmission with a high sensitivity (83%), specificity (77%), and area under the receiver operating characteristic curve of 86%.

Conclusions: Although preliminary, these results suggest that inpatients with BD who have higher levels of BPD features were more likely to have depressive rather than manic symptoms, fewer psychotic symptoms, and a shorter LOS. Moreover, machine learning models may be particularly valuable in identifying patients with BD who are at the highest risk for adverse consequences including rapid readmission.

SALEM, RUIZ, HERNANDEZ, WAHID, KARNES, BEASLEY, SANCHES, ASHTARI, PIGOTT: Harris County Psychiatric Center (HCPC) and Department of Psychiatry and Behavioral Science, McGovern School of Medicine, University of Texas Health Science Center at Houston, TX

CAO: Department of Psychiatry, University of Missouri at Kansas City, MO

The authors declare no conflicts of interest.

Please send correspondence to: Haitham Salem, MD, PhD, McGovern School of Medicine, Harris County Psychiatric Center (HCPC), University of Texas Health Science Center at Houston, 1941 East Road, Suite 3234, Houston, TX 77054 (email: haitham.salem@uth.tmc.edu).

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