Comparison of the Patient Groups with and Without Dissociative Disorder Comorbidity among the Inpatients with Bipolar Disorder

Yatarak Tedavi Goren Bipolar Bozukluk Hastalarinda Dissosiyatif Bozukluk Estanisi Olan ve Olmayan Hasta Gruplarinin Karsilastirilmasi Bahadir Bakim 1 , Elif Baran 2 , Mehmet Diyaddin Guleken 3 , Onur Tankaya 4 , Sinan Yayla 5 , Abdullah Akpinar 6 , Hakan Serdar Sengul 7 , Hulya Ertekin 8 , Omer Akil Ozer 2 , Kayihan Oguz Karamustafalioglu 9 1 Ruh Sagligi ve Hastaliklari Ana Bilim Dali, Tip Fakultesi, Istanbul Yeni Yuzyil Universitesi, Istanbul, Turkiye 2 Psikiyatri Klinigi, Şisli Hamidiye Etfal Egitim ve Arastirma Hastanesi, Istanbul, Turkiye 3 Gazi Yasargil Egitim ve Arastirma Hastanesi, Diyarbakir, Turkiye 4 Ruh Sagligi Hastaliklari Hastanesi, Samsun, Turkiye 5 Corlu Devlet Hastanesi, Tekirdag, Turkiye 6 Ruh Sagligi ve Hastaliklari Ana Bilim Dali, Tip Fakultesi, Suleyman Demirel Universitesi, Isparta, Turkiye 7 Taksim Ilk Yardim Hastanesi, Istanbul, Turkiye 8 Ruh Sagligi ve Hastaliklari Ana Bilim Dali, Tip Fakultesi, Canakkale, Turkiye 9 Uskudar Universitesi, Istanbul, Turkiye ABSTRACT Introduction: This study aims to compare sociodemographic characteristics of the patients with bipolar disorder (BD) with and without comorbid dissociative disorder (DD) and to investigate the eventual effect of the comorbidity on the treatment. Methods: We enrolled a total of 149 patients diagnosed with BD and treated as inpatients consecutively in Şisli Etfal Hospital, Psychiatry Clinic between 2010 and 2011. For the patients who were diagnosed with DD using SCID-D and with BD using SCID-I, sociodemographic characteristics, YMRS, HAM-D, BPRS, DES scores and duration and number of hospital stays were evaluated. Results: 23 patients (15.4%) had dissociative disorder not otherwise specified (DD-NOS), 4 patients (2.6%) had dissociative identity disorder (DID) and 1 patient (0.6%) had dissociative amnesia. BD patients with comorbid DD were found to be predominantly female (p=0.015) and younger (p=0.002) and to have significantly higher DES scores than BD patients without DD (p<0.001). The total score of DES was correlated with duration hospital stay (p=0.001, Spearman r=0.336) in the total sample. Total HAM-D score at the time of admission was significantly higher in the comorbidity group (p=0.027), and suicide item was found to be significantly higher both at admission and at discharge (p<0.001 and p=0.035). Among BPRS scores at admission, hallucinatory behavior item was found to be higher in the comorbidity group (p=0.019). Among YMRS scores both at admission and at discharge, velocity and amount of speech item (p=0.027) and insight item at admission (p=0.006) was found to be significantly higher in the pure bipolar group (p=0.018). Conclusion: In patients with BD, DD comorbidity should be investigated. The BD patients with DD comorbidity tend to be female and younger, and show higher depression scores, leading to a prolonged hospital stay. In the presence of dissociation comorbidity, attempts and number of suicides and hallucinatory behaviors seem to be increased. Keywords: bipolar disorder, dissociative disorder, comorbidity OZET Giris: Bu calismada dissosiyatif bozukluk (DB) estanisi olan ve olmayan bipolar bozukluk (BB) hastalarinin sosyodemografik karakteristiklerinin karsilastirilmasi ve estani varliginin tedaviye etkisinin degerlendirilmesi amaclanmistir. Yontem: BB tanisi ile Şisli Etfal Hastanesi Psikiyatri Klinigi’nde 2010-2011 yillari arasinda yatisi yapilan ardisik 149 hasta calismaya alinmistir. Hastalara SCID-D uygulanarak DB tanisi, SCID-I ile BB tanisi konmus, sosyodemografik karakteristikleri, YMDO, HAM-D, KPDO, DYO puanlari ve hastanede yatis sure ve sayilari incelenmistir. Bulgular: 23 hastada (%15,4) baska turlu adlandirilamayan dissosiyatif bozukluk, 4 hastada (% 2,6) dissosiyatif kimlik bozuklugu, 1 hastada (%0,6) dissosiyatif amnezi tespit edildi. DB estanisi olan BB hastalarinin daha genc ve daha fazla oranda kadin oldugu belirlendi (sirasiyla p=0,002, p=0,015). DB estanili BB hastalarinin DYO toplam puaninin BB hastalarin daha yuksek oldugu tespit edildi (p<0,001). Tum orneklemde DYO toplam puani ile hastanede kalis suresi arasinda korelasyon bulunmustur (p=0,001, Spearman r=0.336). Basvuru sirasinda toplam HDO puani estanili grupta anlamli olarak daha yuksek (p=0,027), intihar maddesi hem basvuru hem taburculukta anlamli olarak yuksek bulunmustur (p<0,001 ve p=0,035). Basvuru esnasinda KPDO puanlarindan, halusinatuar davranis maddesi estanili grupta yuksek bulunmustur (p=0,019). YMDO puanlarindan konusma hiz ve miktari hem basvuru hem taburculukta (sirasiyla p=0,027, p=0,006), icgoru maddesi ise basvuru esnasinda estaninin olmadigi bipolar hasta grubunda yuksek bulunmustur (p=0,018). Sonuc: BB hastalarinda DB estanisi sorgulanmalidir. DB estanili hastalarin daha cok kadin cinsiyette ve daha genc yasta oldugu, daha fazla depresyon puanlarina sahip oldugu; daha uzun sureli hastanede kalis suresine sahip oldugu bulunmustur. Dissosiyasyon estanisi varliginda, intihar girisim sayisi ve halusinatuar davranislarda artis gorulebilir. Anahtar kelimeler : Bipolar bozukluk, disosiyatif bozukluk, komorbidite Submission / Basvuru: April / Nisan 20, 2016                Acceptance / Kabul: July / Temmuz 13, 2016 Correspondence / Yazisma: Istanbul Yeni Yuzyil Universitesi Tip Fakultesi, Istanbul, Turkiye E-mail: bbakim@yahoo.com Cite / Atif: Bakim B, Baran E, Guleken MD, Tankaya O, Yayla S, Akpinar A, Sengul HS, Ertekin H, Ozer OA, Karamustafalioglu KO. Comparison of the patient groups with and without dissociative disorder comorbidity among the inpatients with bipolar disorder. Fam Pract Palliat Care. 2016;1(2):35-42