Abstract
Introduction: Borderline personality disorder (BPD) is a serious psychological condition characterised by unstable interpersonal relationships, distorted self-image, affective instability, marked impulsivity and suicidal behaviours, and is associated with high rates of comorbid psychiatric illness [1-3]. Though medications are often used to treat specific core symptoms, currently there are no approved pharmacological treatments for BPD [1].
Aim: To describe the clinical characteristics of patients with BPD at first diagnosis to help identify unmet patient needs.
Methods: This study leveraged electronic health record-derived, de-identified data from the Holmusk NeuroBlu Database (Version 21R2), a longitudinal behavioural health real-world database comprising structured/unstructured patient-level clinical data from 25 United States mental health providers [4]. Patients (aged ≥12 years) with ≥1 diagnosis of BPD between 2001 and 2020 were included. The baseline period was +/-14 days from the first recorded date of BPD diagnosis. Baseline clinical features including psychiatric comorbidities and BPD symptoms (from Mental State Examination data derived using natural language processing [5]) were extracted. Disease severity was assessed according to the clinical global impression-severity (CGI-S) categories; 1–3 (normal-to-mildly ill), 4–5 (moderately-to-markedly ill) and 6–7 (severely-to-most-extremely ill). Hospitalisation and pharmacological treatment patterns at 12 months prior to diagnosis and at baseline were recorded. Data were analysed using descriptive statistics.
Results: 13,444 patients were included; the mean age (standard deviation [SD]) was 33.0 (12.8) years, 84.0% were female and 59.0% were white. A large majority (98.0%) had psychiatric comorbidities diagnosed at baseline. Of the 13,033 with comorbidities, the most frequent were major depressive disorder (45.7%), substance use disorder (SUD, 34.6%), posttraumatic stress disorder (29.2%) and anxiety disorders (27.6%). Alcohol (17.3%) and cannabis (12.7%) were the most commonly reported substances in the SUD category. Of the 12,205 patients with BPD symptoms at baseline, the most frequently reported symptoms were emotional dysregulation (35.8%; of which anger/irritability was most common [21.4%]) and suicidal intent/ideation (31.3%). While frequency of emotional dysregulation symptoms increased with age, suicidal intent/ideation and suicidal attempt/self-injury were more prevalent in younger patients. The mean (SD) CGI-S score at baseline was 4.6 (1.1) with 67.4% of patients categorised as moderately-to-markedly ill. More patients were prescribed pharmacological treatments prior to baseline when compared with the baseline period (79.5% vs 67.7%); the most common were antidepressants (64.2% vs 51.2%), second-generation antipsychotics (45.1% vs 34.5%) and anticonvulsants (44.6% vs 33.8%). For patients not receiving treatment at baseline (32.3%), the median (interquartile range) time to first treatment was 57 (149) days. Among patients with recorded psychiatric hospitalisations in the 12 months prior to baseline and at baseline, 49.7% and 41.7% respectively had ≥2 hospitalisations.
Conclusion: Almost all patients with BPD had psychiatric comorbidities at baseline. The high proportion of patients with hospitalisations and prescribed pharmacological treatments at 12 months prior to the baseline highlights the complex symptomology and burden of delayed diagnosis faced by patients with BPD. These results indicate the need for a better understanding of BPD to help identify unmet patient needs.
References
[1] Gartlehner, G., Crotty, K., Kennedy, S., Edlund, M.J., Ali, R., Siddiqui, M., Fortman, R., Wines, R., Persad, E., Viswanathan, M., 2021. Pharmacological Treatments for Borderline Personality Disorder: A Systematic Review and Meta-Analysis. CNS Drugs 35, 1053-1067. [2] American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders, fifth ed. American Psychiatric Association Publishing, Washington. [3] Shah, R., Zanarini, M.C., 2018. Comorbidity of Borderline Personality Disorder: Current Status and Future Directions. Psychiatr Clin North Am 41(4), 583-593. [4] Patel, R., Wee, S.N., Ramaswamy, R., Thadani, S., Tandi, J., Garg, R., Calvanese, N., Valko, M., Rush, A.J., Rentería, M.E., Sarkar, J., Kollins, S.H., 2022. NeuroBlu, an electronic health record (EHR) trusted research environment (TRE) to support mental healthcare analytics with real-world data. BMJ Open 12, e057227. [5] Mukherjee, S.S., Yu, J., Won, Y., McClay, M.J., Wang, L., Rush, A.J., Sarkar, J., 2020. Natural Language Processing-Based Quantification of the Mental State of Psychiatric Patients. Computational Psychiatry 4(0), 76-106.
Conflict of interest:
Disclosure statement:
Carissa White, Suzanne St.Rose and Jennifer Dwyer are employees of Boehringer Ingelheim.
Emily OC Palmer, Mayowa Oyesanya and Kira Griffiths are employees of Holmusk Europe Ltd. Joannas Yeow and Benjamin Chee are employees of Holmusk Technology Inc.
Rashmi Patel has received grant funding from the National Institute for Health and Care Research (NIHR301690), the Medical Research Council (MR/S003118/1), the Academy of Medical Sciences (SGL015/1020) and Janssen, personal fees from Holmusk, and honoraria from Boehringer Ingelheim.
Funding: This study is funded by Boehringer Ingelheim.
Aim: To describe the clinical characteristics of patients with BPD at first diagnosis to help identify unmet patient needs.
Methods: This study leveraged electronic health record-derived, de-identified data from the Holmusk NeuroBlu Database (Version 21R2), a longitudinal behavioural health real-world database comprising structured/unstructured patient-level clinical data from 25 United States mental health providers [4]. Patients (aged ≥12 years) with ≥1 diagnosis of BPD between 2001 and 2020 were included. The baseline period was +/-14 days from the first recorded date of BPD diagnosis. Baseline clinical features including psychiatric comorbidities and BPD symptoms (from Mental State Examination data derived using natural language processing [5]) were extracted. Disease severity was assessed according to the clinical global impression-severity (CGI-S) categories; 1–3 (normal-to-mildly ill), 4–5 (moderately-to-markedly ill) and 6–7 (severely-to-most-extremely ill). Hospitalisation and pharmacological treatment patterns at 12 months prior to diagnosis and at baseline were recorded. Data were analysed using descriptive statistics.
Results: 13,444 patients were included; the mean age (standard deviation [SD]) was 33.0 (12.8) years, 84.0% were female and 59.0% were white. A large majority (98.0%) had psychiatric comorbidities diagnosed at baseline. Of the 13,033 with comorbidities, the most frequent were major depressive disorder (45.7%), substance use disorder (SUD, 34.6%), posttraumatic stress disorder (29.2%) and anxiety disorders (27.6%). Alcohol (17.3%) and cannabis (12.7%) were the most commonly reported substances in the SUD category. Of the 12,205 patients with BPD symptoms at baseline, the most frequently reported symptoms were emotional dysregulation (35.8%; of which anger/irritability was most common [21.4%]) and suicidal intent/ideation (31.3%). While frequency of emotional dysregulation symptoms increased with age, suicidal intent/ideation and suicidal attempt/self-injury were more prevalent in younger patients. The mean (SD) CGI-S score at baseline was 4.6 (1.1) with 67.4% of patients categorised as moderately-to-markedly ill. More patients were prescribed pharmacological treatments prior to baseline when compared with the baseline period (79.5% vs 67.7%); the most common were antidepressants (64.2% vs 51.2%), second-generation antipsychotics (45.1% vs 34.5%) and anticonvulsants (44.6% vs 33.8%). For patients not receiving treatment at baseline (32.3%), the median (interquartile range) time to first treatment was 57 (149) days. Among patients with recorded psychiatric hospitalisations in the 12 months prior to baseline and at baseline, 49.7% and 41.7% respectively had ≥2 hospitalisations.
Conclusion: Almost all patients with BPD had psychiatric comorbidities at baseline. The high proportion of patients with hospitalisations and prescribed pharmacological treatments at 12 months prior to the baseline highlights the complex symptomology and burden of delayed diagnosis faced by patients with BPD. These results indicate the need for a better understanding of BPD to help identify unmet patient needs.
References
[1] Gartlehner, G., Crotty, K., Kennedy, S., Edlund, M.J., Ali, R., Siddiqui, M., Fortman, R., Wines, R., Persad, E., Viswanathan, M., 2021. Pharmacological Treatments for Borderline Personality Disorder: A Systematic Review and Meta-Analysis. CNS Drugs 35, 1053-1067. [2] American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders, fifth ed. American Psychiatric Association Publishing, Washington. [3] Shah, R., Zanarini, M.C., 2018. Comorbidity of Borderline Personality Disorder: Current Status and Future Directions. Psychiatr Clin North Am 41(4), 583-593. [4] Patel, R., Wee, S.N., Ramaswamy, R., Thadani, S., Tandi, J., Garg, R., Calvanese, N., Valko, M., Rush, A.J., Rentería, M.E., Sarkar, J., Kollins, S.H., 2022. NeuroBlu, an electronic health record (EHR) trusted research environment (TRE) to support mental healthcare analytics with real-world data. BMJ Open 12, e057227. [5] Mukherjee, S.S., Yu, J., Won, Y., McClay, M.J., Wang, L., Rush, A.J., Sarkar, J., 2020. Natural Language Processing-Based Quantification of the Mental State of Psychiatric Patients. Computational Psychiatry 4(0), 76-106.
Conflict of interest:
Disclosure statement:
Carissa White, Suzanne St.Rose and Jennifer Dwyer are employees of Boehringer Ingelheim.
Emily OC Palmer, Mayowa Oyesanya and Kira Griffiths are employees of Holmusk Europe Ltd. Joannas Yeow and Benjamin Chee are employees of Holmusk Technology Inc.
Rashmi Patel has received grant funding from the National Institute for Health and Care Research (NIHR301690), the Medical Research Council (MR/S003118/1), the Academy of Medical Sciences (SGL015/1020) and Janssen, personal fees from Holmusk, and honoraria from Boehringer Ingelheim.
Funding: This study is funded by Boehringer Ingelheim.
| Original language | English |
|---|---|
| Article number | 102633 |
| Pages (from-to) | 96 |
| Number of pages | 97 |
| Journal | Neuroscience Applied |
| Volume | 2 |
| Issue number | S2 |
| DOIs | |
| Publication status | Published - 26 Dec 2023 |