.. What measures should be used to diagnose personality disorders? Several instruments exist, and while there is no evidence that any one interview schedule is more reliable or valid than another, there is consistent evidence that prevalence rates are higher based on self-administered Fulvestrant in vitro scales than clinician interviews.41-43 When should personality disorders be assessed during the course of the mood disorder? The impact of psychiatric state on personality disorder assessment Inhibitors,research,lifescience,medical has been well established,

and to minimize this effect some researchers evaluate personality disorders after a patient has improved and is in a euthymic state.44-46 The potential problem with this approach is that it underestimates the prevalence of personality disorders because the presence of personality pathology Inhibitors,research,lifescience,medical predicts poorer outcome. Therefore, we included all studies, regardless of when personality disorders were assessed, with the plan to examine the potential impact of psychiatric state on prevalence rates. Excluded studies To obtain a systematic and comprehensive collection of published

studies of comorbidity, we conducted a Medline and Psyclnfo search on the terms bipolar and borderline. We reviewed the titles from this search to identify studies that Inhibitors,research,lifescience,medical potentially included information on the comorbidity of bipolar disorder and BPD. We also identified studies in reference lists of identified studies and review articles. Several studies that have been included in other reviews of bipolar disorder-BPD comorbidity were excluded from the present review. Self-report measures of personality disorders are more appropriately considered screening instruments than diagnostic measures. Consistent Inhibitors,research,lifescience,medical with this, as noted above, prevalence rates based on self-report scales Inhibitors,research,lifescience,medical are higher than those based on clinician-administered interviews. We therefore did not include studies that relied on self-report scales to make personality disorder diagnoses.47-49 We also did not include studies in which the personality disorder diagnoses were based on unstructured clinical evaluations46,50-57 because these evaluations

are less reliable58,59 and underdetect personality disorders.20,60 Dichloromethane dehalogenase Studies in which diagnoses were based on chart review were also excluded61,62 because diagnoses were based on unstructured evaluations. Reports based on overlapping samples were included only once. We included the data from Pica et al,63 but not from Jackson et al64 and Turley et al,65 because the samples included the same patients. Similarly, the data in Colom et al66 was not included because it overlaps with Vieta et al.67,68 Two papers from the Collaborative Longitudinal Personality Study reported the frequency of bipolar disorder in patients with BPD.69,70 The Skodol et al70 report was based on all patients diagnosed with BPD, including BPD diagnosed in patients with other primary personality disorders.