Philippe Conus1,2, Melissa Hasty2, Craig Macneil2, Sue M Cotton2, Michael Berk3, Linda Kader2, Aswin Ratheesh2, Andrew Chanen2,4; 1Treatment and Early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry CHUV, Lausanne University, Switzerland, 2Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia, 3Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, 4Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
Objectives: Personality disorder (PD) comorbidity is common among patients with bipolar disorder and has been shown to negatively impact on outcome. However, little is known about this comorbidity in the early phases of BD. We aimed to examine the prevalence and impact of PD comorbidity on outcome in a cohort of youth with first episode mania (FEM) with psychotic features. Methods: Seventy-one patients with FEM aged 15 to 29 and treated at the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne, Australia, were assessed at baseline, 6, 12, and 18 months as part of a randomized controlled trial of olanzapine and chlorpromazine as add-on to lithium in FEM with psychotic features. This study involved secondary analysis of trial data. Results: A comorbid clinical PD diagnosis was made in 16.9% of patients, antisocial and narcissistic PD being the most common sub-types. Patients with PD comorbidity had higher rates of readmission to hospital, lower rates of symptomatic recovery and poorer functional levels at 6 months, but these differences were not maintained after 12 and 18 months. Conclusions: In the early phase of bipolar disorders, patients with PD comorbidity display a delay in reaching symptomatic and functional recovery and are more likely to need hospital readmissions. These observations suggest specific intervention might be needed in order to improve short-term treatment efficacy in this subgroup.
