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Borderline or Bipolar: Can 3 Questions Differentiate Them?

The Prisoner’s Dilemma paradigm separates the two, but that’s not practical as a clinical tool.

Borderline or Bipolar: Can 3 Questions Differentiate Them?

January 10, 2017 | Bipolar Disorder, Mood Disorders
By James Phelps, MD

Treatments for borderlinity and bipolarity are quite different. Which approach should you consider for a patient with impulsive risk-taking, episodes of irritability and hostility, fractured relationships, substance use problems, and severe depressions with brief phases of remission (maybe too good?) in between?

The Prisoner’s Dilemma paradigm separates the two,1 but that’s not practical as a clinical tool. What if you could pluck just 3 items from a standard bipolar screening questionnaire and increase your diagnostic certainty by 30% when faced with this common differential? That may be possible, based on a new study from Nassir Ghaemi and colleagues, led by Paul Vöhringer.2

Of course, replication studies will be needed before we can declare a new diagnostic approach is at hand. But in the meantime, I hope you might be curious: what 3 items from the good old Mood Disorders Questionnaire (MDQ)3 were so discriminating?

Vöhringer et al2 obtained an MDQ from 260 patients whose diagnosis was then established by structured interview (the usual gold standard in this kind of study). Then they analyzed the individual MDQ items looking for those that discriminate well between bipolar disorders and borderline personality disorder. They found 3, a “clinical triad,” that had remarkable statistical power:

1. Elevated mood: “You felt so good or so hyper that other people thought you were not your normal self or you were so hyper that you got into trouble?”

2. Increased goal-directed activities: “You were much more active or did many more things than usual?”

3. Episodicity of mood symptoms: “If you checked YES to more than one of the above, have several of these ever happened during the same period of time?”

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