Background: The reasons for the high rates of comorbidity between
Bipolar (BD) and Borderline Personality (BPD) disorders remain elusive, due
to the vast array of shared clinical features, which makes the differential
diagnosis difficult. This constitutes an obstacle to provide quality of care
services, which results in detrimental effects on individual’s mental
health. The analysis of the complex network of connections between symptoms
of both disorders is a promising pathway to uncover the mechanisms
underlying the comorbidity structure of both disorders. Goals: In this
study, we explored the comorbidity network that represents the connections
between 32 DSM-5 symptoms of BD and BPD in order to (1) compare its modular
structure (i.e., the constitution of cohesive subgroups of symptoms within
the comorbidity network) with the nosographic proposal of the DSM-5; (2)
distinguish between the different roles those symptoms have in the
comorbidity network and identify the symptoms that overlap and bridge both
disorders, as well as the distinctive symptoms that better discriminate
them; (3) identify the most central symptoms and those with the highest
impact on the strength or on the structure of the connections on the
comorbidity network; and (4) analyze the association between symptoms roles
and their centrality and impact.Methods: An epidemiological sample from the
National Comorbidity Survey: Baseline (NCS) was analyzed. Data regarding
bipolar and borderline personality symptoms were collected through the
Composite Network International Diagnostic Interview (CIDI). The network of
complex interactions between symptoms was estimated using the Ising model
with the L1-regularization penalty (EBIC) and the nosographic structure was
detailed with Moduland algorithms. Results: Data regarding an overall sample
of 7556 individuals was analyzed (48.6% male, Mage = 33.400 years, SDage =
10.447). Results revealed differences between the modular structure of the
comorbidity network and the DSM-5 nosographic proposal, namely about
unstable relationships and substance abuse, that were assigned to the module
constituted by symptoms of manic episode (ME). Symptoms such as money
spending and sexual indiscretions, that overlap ME and BPD in the DSM-5,
were assigned to the ME module. Psychomotor agitation, which overlaps
depressive episode (DE) and ME in the DSM-5, was assigned to the DE module.
Additionally, emptiness and worthlessness were identified as bridge symptoms
between DE and BPD; anger and substance abuse between ME and BPD; and
unstable relationships and psychomotor agitation between DE and ME. Fatigue
was the most distinctive symptom of the DE module, unstable relationships of
the ME module, and anger of the BPD module. Strength centrality (r = .61,
95%CI [.33, .79], p < .001) and modular bridgeness (r = .64, 95%CI [.38,
.81], p < .001) were positively correlated with the impact on the
structure of the comorbidity network; and modular overlap was negatively
correlated with the impact on the strength (r = -.43, 95%CI [-.10, -.68], p
= .01) of its connections. Discussion: Results suggest a similar structure
of the comorbidity network to the nosographic proposal of DSM-5. Distinctive
and bridge symptoms were identified for each disorder which might help with
the differential diagnosis. It can also help us to unveil possible
development pathways of comorbidity that might promote an improvement in
psychological treatments. Keywords: Bipolar disorder, Borderline personality
disorder, Network analysis, Comorbidity.
Mania Induzida por Mirtazapina: Um Caso Clínico
