Bipolar Disorder and Comorbid Borderline Personality Disorder: Patient Characteristics and Outcomes in US Hospitals

Background and objectives: The quality of life and disease outcomes in bipolar patients, including increased risk of psychiatric hospitalizations and suicide, are adversely affected by the presence of borderline personality disorder (BPD). Our study aims to determine the impact of BPD on the inpatient outcomes of bipolar disorder patients. Methods: We used Nationwide Inpatient Sample from the US hospitals and identified cases with bipolar disorder and comorbid BPD (N = 268,232) and controls with bipolar disorder only (N = 242,379), using the International Classification of Diseases, 9th Revision, and Clinical Modification codes. We used multinomial logistic regression to generate odds ratios (OR) and evaluate inpatient outcomes. Results: The majority of the bipolar patients with BPD were female (84.2%), Caucasian (83.1%) and 18–35 years age (53.9%). Significantly longer inpatient stays, higher inpatient charges, and higher prevalence of drug abuse were noted in bipolar patients with BPD. The suicide risk was higher in bipolar patients with BPD (OR = 1.418; 95% CI 1.384–1.454; p <0.001). In addition, utilization of electroconvulsive treatment (ECT) was higher in bipolar patients with comorbid BPD (OR = 1.442; 95% CI 1.373–1.515; p <0.001). Conclusions: The presence of comorbid BPD in bipolar disorder is associated with higher acute inpatient care due to a longer inpatient stay and higher cost during hospitalization, and higher suicide risk, and utilization of ECT. Further studies in the inpatient setting are warranted to develop effective clinical strategies for optimal outcomes and reduction of suicide risk in bipolar patients with BPD

Importance of Behavioral Therapy in Patients Hospitalized for Post-Traumatic Stress Disorder (PTSD) with Opioid Use Disorder

Objective: To analyze differences in demographic pattern and hospitalization outcomes in post-traumatic stress disorder (PTSD) with opioid use disorder (OUD) patients managed with versus without behavioral therapy (BT). Methods: We conducted case-control study using Nationwide Inpatient Sample and identified PTSD and OUD using ICD–9–CM codes. Linear regression model was used to evaluate impact of BT on inpatient stay and cost. Results: We analyzed 1531 inpatient admissions and 786 patients received BT. Females had higher odds of receiving BT during inpatient management for PTSD with OUD (OR 1.210; 95% CI 1.020–1.436). About 63.1% patients receiving BT were benefited by Medicaid. Patients receiving BT had an increase in hospital stay by 1.27 days (P = 0.085) and hospitalization cost by $4734 (P = 0.018). There were no transfers to short term hospitals and lower transfers to skilled nursing facility (3.8% vs. 10.1%) in patients receiving BT. Conclusion: This study aims to reinforce combination management with psychotropic medications and BT in PTSD patients with comorbid OUD during hospitalization as it significantly decreases adverse disposition of the patient and thereby improves the quality of life post-treatment

Suvorexant for insomnia in older adults: a perspective review

The aim of this review was to identify published randomized control trials (RCTs) that evaluated the efficacy and tolerability of suvorexant for the treatment of insomnia among older adults (≥65 years). A literature search was conducted of PubMed, MEDLINE, EMBASE, PsycINFO and Cochrane collaboration databases for RCTs in any language evaluating suvorexant for the treatment of insomnia in older adults. Additionally, references of full-text articles that were included in this review were searched for further studies. Data from three RCTs of suvorexant were included in this review. All the three studies fulfilled the criteria for being of good quality based on the items listed by the Center for Evidence Based Medicine (CEBM) for the assessment of RCTs. None of the three studies were conducted exclusively among older adults. However, they also included older individuals diagnosed with primary insomnia. These studies included a total of 1298 participants aged ≥65 years in age. Trial durations ranged from 3 months to 1 year. Available data from these studies indicate that suvorexant improves multiple subjective and polysomnographic sleep parameters for sleep onset and maintenance among older individuals with a diagnosis of primary insomnia and is generally well tolerated. Current evidence, although limited, indicates that suvorexant benefits older adults with primary insomnia and is generally well tolerated