BIPOLAR SPECTRUM DIAGNOSTIC SCALE BSDS PDF

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Metrics details. This study examined the accuracy of these scales for detecting bipolar disorder among patients referred for eating disorders and explored the possibility of simultaneous assessment of co-morbid borderline personality disorder. Participants were 78 consecutive female patients who were referred for evaluation of an eating disorder. Among patients being evaluated for eating disorders, the MDQ and BSDS show promise as screening questionnaires for both bipolar disorder and borderline personality disorder.

Peer Review reports. As bipolar disorders are serious mental disorders that can cause severe lifelong functional impairment, early recognition of the diagnosis and early introduction of mood stabilizers are crucial for improvement of outcomes [ 1 ].

Nonetheless, most patients with bipolar disorder go years before receiving an appropriate diagnosis and starting mood stabilizers [ 1 ]. Borderline personality disorder is the most common personality disorder in clinical settings, and causes marked distress and impairment in social, occupational, and role functioning [ 2 ].

Yet, similar to bipolar disorder, borderline personality disorder is often incorrectly diagnosed or underdiagnosed in clinical practice [ 2 ]. Both bipolar and borderline personality disorders are associated with high rates of completed suicide [ 1 , 2 ] and are common among patients with mood disorders [ 1 , 2 ] and eating disorders [ 3 , 4 ].

Recently, the boundary of these disorders has been a focus of debate [ 5 — 9 ]. There are two viewpoints about the relationship between bipolar disorder, especially bipolar II disorder, and borderline personality disorder. The first one is that underlying cyclothymic temperament can explain the relationship, and borderline personality disorder [ 9 ] as well as bulimia nervosa [ 8 ] are variants of bipolar disorders. These instruments show good psychometric properties to detect bipolarity among patients with unipolar depression and are recommended as screening tools for bipolar disorders among patients with unipolar depression [ 1 ].

However, Zimmerman et al. Patients diagnosed with bipolar disorder by previous doctors were significantly more likely to be diagnosed with borderline personality disorder compared to patients who were not diagnosed with bipolar disorder Viewed another way, these results suggest the possibility that both bipolar and borderline personality disorders can be simultaneously detected by these scales.

To the best of our knowledge, the MDQ and BSDS have never been used to detect bipolar disorders or borderline personality disorder among eating disorder patients, despite the relatively high comorbidity rates of these disorders [ 3 , 4 ].

In contrast to common attention towards impulsivity and borderline personality disorder among eating disorder patients [ 4 ], the presence of comorbid bipolar disorder has rarely received attention of eating disorder specialists [ 15 ]. However, some evidence suggests increased prevalence of bipolar II disorder [ 16 ], ego-syntonic hypomania may escape clinical detection, and comorbid bipolar disorder requires special therapeutic considerations [ 3 ].

Thus, screening scales for bipolar disorder might be more important than eating disorder specialists traditionally thought. The aim of the current study was to examine the diagnostic accuracy including sensitivity and specificity of the MDQ and BSDS to detect bipolar disorders among patients that were referred for evaluation of an eating disorder.

We also explored the possibility that the two scales can detect borderline personality disorder among this population. We hypothesized that the diagnostic accuracy of the two screening tests MDQ and BSDS for borderline personality disorder might be similar to that for bipolar disorders. The patients with eating disorder not otherwise specified EDNOS were not excluded as prior research has shown these patients often are referred for eating disorder treatment and may have comorbid bipolar or borderline personality disorder [ 17 ].

Of the ninety patients who were screened, seventy-eight patients enrolled in the study, and all enrollees completed the study. Of the twelve patients that did not participate in the study, six deemed their psychiatric problem minor and opted to cope with the difficulty, four were reluctant to undergo detailed psychiatric assessment, and two declined to participate for unknown reasons.

As part of routine clinical care, patients received cognitive behavioral therapy, dialectical behavioral therapy, or medication management depending on the results of their assessment, even when their provisional primary diagnosis defined as the disorder most influencing their global functioning was other than an eating disorder.

All patients provided written informed consent before entering the study. This study was approved by the institutional review committee of the Osaka City University Graduate School of Medicine.

The symptom questions are followed by a single question about whether the symptoms clustered during the same period. The final question evaluates the level of impairment resulting from the symptoms on a 4-point scale no, minor, moderate, or serious problems. In a Japanese study of unipolar depressive patients, a lower cut-off of more than 5 with minor or greater problems was proposed [ 19 ].

The BSDS consists of two parts: first, a paragraph containing 19 statements describing many of the symptoms of bipolar disorder, and, second, a single multiple-choice question asking respondents how well the paragraph describes them.

The total score ranges from 0 to A score of 13 for the original version [ 11 ], 12 for the Chinese version [ 20 ], and 11 for the Japanese version [ 19 ] have been proposed as cut-off points. All participants underwent a direct face-to-face assessment conducted by T. To the best of our knowledge, no previous study has explored the possibility that the two scales might detect borderline or histrionic personality disorders.

Given this, we used the same cut-off point to detect the personality disorders as for bipolar disorder. All data were analyzed with SPSS A high level of functional impairment was suggested by the high rate of single participants around two-thirds , unemployment around half and chronicity around ten years. No patients had bipolar I disorder. No patients with anorexia nervosa restricting subtype or restricting EDNOS had bipolar, borderline, or histrionic personality disorders.

Further, these two scales showed comparable accuracy in detecting borderline personality disorder. Since accuracy for detecting histrionic personality disorder was relatively low, just bipolar II disorder and borderline personality disorder were the focus of the following analyses. Results were similar for detecting bipolar II disorder without comorbid borderline personality disorder and borderline personality disorder without comorbid bipolar II disorder. Receiver Operating Characteristic ROC curve of diagnostic accuracy of score on question one of the mood disorder questionnaire; Bipolar II disorder left and borderline personality disorder right.

Receiver Operating Characteristic ROC curve of diagnostic accuracy of score on the mood disorder questionnaire; Bipolar II disorder without borderline personality disorder left and borderline personality disorder without bipolar II disorder right.

In order to control for the effect of co-morbidity accounting for the diagnostic accuracy of the scales, ROC curves were also calculated for patients with bipolar II disorder but not borderline personality disorder and vice versa.

Results remained statistically significant except for the MDQ detecting borderline personality disorder without comorbid bipolar II disorder. Receiver Operating Characteristic ROC curve of diagnostic accuracy of score on question one of the bipolar spectrum diagnostic scale; Bipolar II disorder left and borderline personality disorder right.

Receiver Operating Characteristic ROC curve of diagnostic accuracy of score on the bipolar spectrum diagnostic scale; Bipolar II disorder without borderline personality disorder left and borderline personality disorder without bipolar II disorder right.

Prior research has suggested that the MDQ and BSDS are useful instruments to detect bipolar disorders among patients with recurrent depressive episodes [ 10 , 11 ]. The current study expands on this work by showing that these two scales can detect bipolar disorder among patients with eating disorders. Both the MDQ and BSDS screening scales exhibited similar value in terms of predictive validity in a population of patients presenting to a psychiatric clinic in a tertiary-care setting.

By comparison, the AUC was 0. In addition, this study suggests that bipolar disorder and borderline personality disorder can both be detected with moderate accuracy by use of a brief screening instrument, although it was difficult for these scales to detect histrionic personality disorder.

Results were similar even after controlling for co-morbidity. This study importantly shows that the two scales can be used as screening tools for borderline personality disorder in a real world setting where eating disorder specialists work. In addition, results showed the assessment of affective instability is useful in terms of bipolar and borderline personality disorder [ 3 ], although impulsivity has traditionally been focused in the eating disorder field [ 4 ].

Accurate diagnosis and distinction of bipolar disorder and borderline personality disorder is important because of the differing treatment approaches. Psychotherapeutic approaches for these two disorders are very different [ 1 , 4 , 29 ].

Also, pharmacotherapy is a core component of treatment for bipolar disorder, but only adjunctive and symptom-targeted for borderline personality disorder [ 1 , 29 ]. These two scales are useful to detect cases that require careful assessment before starting antidepressants, although these scales cannot differentiate between bipolarity and borderline personality disorder.

There are a number of important limitations regarding this study. Sensitivity of these two scales may not be considered sufficiently high using the cut-off point that the original studies suggested. It remains to be known whether the lower sensitivity is due to differences of culture, population, or clinical setting where the participants were recruited.

Results are from a single treatment center, and males and patients with bipolar I disorder were not included. Assessment was cross-sectional, and careful longitudinal consideration is essential because patients with either bipolar or borderline personality disorder can present with similar symptomatology at a given time [ 6 ].

This is especially true in the case of comorbid eating disorder because chaotic eating behaviors and starvation might influence symptomatology [ 30 , 31 ] including dysphoria [ 32 ] and anger [ 9 ]. In addition, we believe these results should encourage further attempts to reconsider the relationship between and symptomatology of bipolar disorder and borderline personality disorder.

Frye MA: Clinical practice. Bipolar disorder--a focus on depression. N Engl J Med. American Psychiatric Association. Am J Psychiatry. Google Scholar. Bipolar Disord. Psychiatry Res. Paris J: The bipolar spectrum: a critical perspective.

Harv Rev Psychiatry. Can J Psychiatr. Bassett D: Borderline personality disorder and bipolar affective disorder. Spectra or spectre? A review. Aust N Z J Psychiatry. J Affect Disord. Perugi G, Fornaro M, Akiskal HS: Are atypical depression, borderline personality disorder and bipolar II disorder overlapping manifestations of a common cyclothymic diathesis?.

World Psychiatr. Compr Psychiatry. J Clin Psychiatry. CNS Drugs. Bipolar II disorder: modelling, measuring and managing. Edited by: Parker G.

Int J Eat Disord. Tanaka T, Koyama T: Rating scales for bipolar disorder: In view of the debate over underdiagnosis and overdiagnosis of bipolar disorder. J Clin Nurs. Akobeng AK: Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice. Acta Paediatr.

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Bipolar Spectrum Diagnostic Scale

Nassir Ghaemi and colleagues. The BSDS arose from Pies's experience as a psychopharmacology consultant, where he was frequently called on to manage cases of " treatment-resistant depression ". Patients are typically diagnosed during their 20s. The English version of the scale consists of 19 question items and two sections. It differs from most scales in that it does not list separate items, but rather presents a short paragraph talking about experiences that people with bipolar spectrum disorders often have. The person checks off which phrases or experiences fit them. Bipolar spectrum disorder includes bipolar I and II, and other cases not meeting criteria for those disorders.

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Metrics details. This study examined the accuracy of these scales for detecting bipolar disorder among patients referred for eating disorders and explored the possibility of simultaneous assessment of co-morbid borderline personality disorder. Participants were 78 consecutive female patients who were referred for evaluation of an eating disorder. Among patients being evaluated for eating disorders, the MDQ and BSDS show promise as screening questionnaires for both bipolar disorder and borderline personality disorder.

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