title: Relationships between mixed features and borderline personality disorder in 2811 patients with major depressive episode.
abstract: OBJECTIVE
  The study focused on the relationship between mixed depression and borderline personality disorder (BPD).
  
  
  METHODS
  The sample comprised 2811 patients with a major depressive episode (MDE). Clinical characteristics were compared in patients with (BPD+) and without (BPD-) comorbid BPD and in BPD+ with (MXS+) and without (MXS-) mixed features according to DSM-5 criteria.
  
  
  RESULTS
  A total of 187 patients (6.7%) met the criteria for BPD. A DSM-IV-TR diagnosis of bipolar disorder (BD) was significantly more frequent in patients with BPD+ than in patients with BPD. Patients with BPD+ were significantly younger and reported lower age at onset than BPD-. Patients with BPD+ also showed more hypomania/mania in first-degree relatives in comparison with patients with BPD-, as well as more psychiatric comorbidity, mixed features, atypical features, suicide attempts, prior mood episodes and antidepressant-induced hypo/manic switches. Mixed features according to DSM-5 criteria were observed in 52 (27.8%) BPD+. In comparison with MXS-, MXS+ were significantly younger at age of onset and at prior mood episode and had experienced more mood episodes and hypo/manic switches with antidepressant treatments.
  
  
  CONCLUSIONS
  Major depressive episode patients with comorbid BPD reported a high prevalence of mixed features and BD. The presence of DSM-5 mixed features in MDE patients with BPD may be associated with complex course and reduced treatment response.
authors.affiliation: University of Pisa, Pisa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Perugi
authors.affiliation: Psychiatrische Universitätsklinik, Zürich, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Angst
authors.affiliation: Hôpital Sainte-Marguerite, Marseille, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Azorin
authors.affiliation: University of Texas Health Center, San Antonio, TX, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Bowden
authors.affiliation: University of Pisa, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Caciagli
authors.affiliation: Moscow Research Institute of Psychiatry, Moscow, Russia.
authors.forename: S
authors.initials: S
authors.lastname: Mosolov
authors.affiliation: Hospital Clinic at the University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Vieta
authors.affiliation: King's College, London, UK.
authors.forename: A H
authors.initials: AH
authors.lastname: Young
keywords: borderline personality; major depression; mixed states