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Randomized Controlled Trial
. 2024 Apr;69(4):275-287.
doi: 10.1177/07067437231213558. Epub 2023 Nov 15.

The Influence of Personality Disorder Symptoms on Treatment Outcomes in Bipolar Disorder: A Secondary Analysis of a Randomised Controlled Trial: L'influence des symptômes du trouble de la personnalité sur les résultats du traitement dans le trouble bipolaire : Une analyse secondaire d'un essai randomisé contrôlé

Alessandra Sarmiento  1 , Olivia M Dean  1   2 , Bianca E Kavanagh  1   3 , Mohammadreza Mohebbi  4 , Michael Berk  1   2   5   6 , Seetal Dodd  1   6 , Sue M Cotton  5   6 , Gin S Malhi  7   8   9 , Chee H Ng  10 , Alyna Turner  1
Affiliations
Randomized Controlled Trial

The Influence of Personality Disorder Symptoms on Treatment Outcomes in Bipolar Disorder: A Secondary Analysis of a Randomised Controlled Trial: L'influence des symptômes du trouble de la personnalité sur les résultats du traitement dans le trouble bipolaire : Une analyse secondaire d'un essai randomisé contrôlé

Alessandra Sarmiento et al. Can J Psychiatry. 2024 Apr.

Abstract
in English, French

Objectives: Many people who are diagnosed with bipolar disorder also have comorbid personality disorder. Few studies have explored how personality disorder may influence pharmacological treatment outcomes. The aim of this study was to conduct a secondary analysis of data from a clinical trial of adjunctive nutraceutical treatments for bipolar depression, to determine whether maladaptive personality traits influence treatment outcomes.

Methods: Scores on the Standardised Assessment of Personality - Abbreviated Scale screener were used to classify participants as having bipolar disorder with (n = 119) and without (n = 29) above threshold personality disorder symptoms (personality disorder). Outcome measures included: The Montgomery Åsberg Depression Rating Scale, Clinical Global Impressions and Improvement Severity Scales, Patient Global Impressions-Improvement scale, Bipolar Depression Rating Scale, Range of Impaired Functioning Tool, Social and Occupational Functioning Assessment Scale and Quality of Life and Enjoyment Scale (Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form). Generalised estimated equations examined the two-way interactions of personality disorder by time or treatment and investigated personality disorder as a non-specified predictor of outcomes.

Results: Over time, the Patient Global Impressions-Improvement scores were significantly higher in those in the personality disorder group. No other significant differences in the two-way interactions of personality disorder by treatment group or personality disorder by time were found. Personality disorder was a significant but non-specific predictor of poorer outcomes on the Bipolar Depression Rating Scale, Range of Impaired Functioning Tool, and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form, regardless of time or treatment group.

Conclusions: This study highlights the potential impact of maladaptive personality traits on treatment outcomes and suggests that the presence of comorbid personality disorder may confer additional burden and compromise treatment outcomes. This warrants further investigation as does the corroboration of these exploratory findings. This is important because understanding the impact of comorbid personality disorder on bipolar disorder may enable the development of effective psychological and pharmacotherapeutic options for personalised treatments.

Objectifs: De nombreuses personnes qui reçoivent un diagnostic de trouble bipolaire (TB) ont également un trouble de la personnalité (TP) comorbide. Peu d’études ont exploré comment le TP peut influencer les résultats du traitement pharmacologique. La présente étude visait à mener une analyse secondaire des données d’un essai clinique de traitements nutraceutiques complémentaires pour la dépression bipolaire, afin de déterminer si les traits de la personnalité inadaptée influencent les résultats du traitement.

Méthodes: Les scores à l’Échelle d'évaluation standardisée de la personnalité abrégée (SAPAS) ont servi à classifier les participants comme ayant un TB avec (n = 119) et sans (n = 29) au-dessus du seuil des symptômes de TP (« TP »). Les mesures des résultats incluaient : l’Échelle d'évaluation de la dépression de Montgomery Åsberg (MADRS), l’Échelle des impressions cliniques globales et l’échelle de gravité des améliorations (CGI-I, CGI-S), Impressions globales des patients–amélioration (PGI-I), Échelle d’évaluation de la dépression bipolaire (BDRS), Gamme de fonctionnement altéré (LIFE-RIFT), Fonctionnement social et professionnel (SOFAS) et Échelle de qualité de vie et de plaisir (Q-LES-Q-SF). Les équations estimées généralisées examinaient les interactions bidirectionnelles du TP selon le temps ou le traitement et investiguaient le TP comme prédicteur non spécifié des résultats.

Résultats: Avec le temps, les scores au PGI-I scores étaient significativement plus élevés que ceux du groupe TP. D’autres différences significatives n’ont pas été trouvées dans les interactions bidirectionnelles du TP par groupe de traitement ou du TP par le temps. Le TP était un prédicteur significatif mais non spécifique de mauvais résultats aux échelles BDRS, LIFE-RIFT, Q-LES-Q-SF, peu importe le temps ou le groupe de traitement.

Conclusions: La présente étude fait ressortir l’effet potentiel des traits de la personnalité inadaptée sur les résultats de traitement, et suggère que la présence d’un TP comorbide peut conférer un fardeau additionnel et compromettre les résultats du traitement. Ceci mérite plus d’investigation tout comme la corroboration de ces résultats exploratoires. C’est important parce que comprendre l’effet du TP comorbide sur le TB peut permettre de développer des options psychologiques et pharmacothérapeutiques efficaces pour des traitements personnalisés.

Keywords: Trouble bipolaire; adjunctive therapies; bipolar disorder; clinical trial; depression; dépression; essai clinique; mania; manie; neuroscience; personality disorder; psychiatrie; psychiatry; thérapies complémentaires; traitement; treatment; trouble de la personnalité.

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Conflict of interest statement

Declaration of Conflicting InterestsOMD has received grant support from the Brain and Behavior Foundation, Simons Autism Foundation, Stanley Medical Research Institute, Deakin University, Lilly, NHMRC and ASBDD/Servier. She has also received in kind support from BioMedica Nutraceuticals, NutritionCare and Bioceuticals. MB has received grant/research support from National Health and Medical Research Council, Wellcome Trust, Medical Research Future Fund, Victorian Medical Research Acceleration Fund, Centre for Research Excellence CRE, Victorian Government Department of Jobs, Precincts and Regions and Victorian COVID-19 Research Fund. He received honoraria from Springer, Oxford University Press, Cambridge University Press, Allen and Unwin, Lundbeck, Controversias Barcelona, Servier, Medisquire, HealthEd, ANZJP, EPA, Janssen, Medplan, Milken Institute, RANZCP, Abbott India, ASCP, Headspace and Sandoz. G.S.M. has received grant or research support from National Health and Medical Research Council, Australian Rotary Health, NSW Health, Ramsay Health, American Foundation for Suicide Prevention, Ramsay Research and Teaching Fund, Elsevier, AstraZeneca, and Servier; has been a speaker for AstraZeneca, Janssen-Cilag, Lundbeck, and Servier; and has been a consultant for AstraZeneca, Janssen Cilag, Lundbeck, and Servier. C.H.N. had served as a consultant for Lundbeck, Grunbiotics, Servier, Janssen-Cilag and Eli Lilly, received research grant support from Lundbeck, and speaker honoraria from Servier, Lundbeck, Sumitomo, Bristol-Myers Squibb, Organon, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Astra-Zenaca, and Pfizer. S.M.C. has received grant support from the NHMRC, the Stanley Medical Research Institute, BeyondBlue, Movember, The University of Melbourne, Australian Catholic University, ARHRF, and Mental Illness Research Fund (Victoria Department of Human Services). A.T. has received travel or grant support from the NHMRC, Deakin University, AMP Foundation, National Stroke Foundation, Hunter Medical Research Institute, Helen Macpherson Smith Trust, Schizophrenia Fellowship NSW, SMHR, ISAD, and the University of Newcastle.

Figures

Figure 1.
Figure 1.
Participant flow diagram.
See this image and copyright information in PMC

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