Search

Background and Objectives: Bipolar Disorder (BD) is a severe psychiatric disorder that worsens quality of life and functional impairment. Personality disorders (PDs), in particular Cluster B personality, have a high incidence among BD patients and is considered a poor prognostic factor. The study of this co-morbidity represents an important clinical and diagnostic challenge in psychiatry. Particularly, clinical overlap has been shown between antisocial personality disorder (ASPD) and BD that could worsen the course of both disorders. We aimed to detect the frequency of ASPD in bipolar patients with greater accuracy and the impact of ASPD on the clinical course of BD. Materials and Methods: A systematic literature search was conducted in PubMed, Embase, MEDLINE and the Cochrane Library through December 2020 without language or time restriction, according to PRISMA statement guidelines. Results: Initially, 3203 items were identified. After duplicates or irrelevant paper deletion, 17 studies met the inclusion criteria and were included in this review. ASPD was more frequent among BD patients, especially in BD type I. BD patients with ASPD as a comorbidity seemed to have early onset, higher number and more severe affective episodes, higher levels of aggressive and impulsive behaviors, suicidality and poor clinical outcome. ASPD symptoms in BD seem to be associated with a frequent comorbidity with addictive disorders (cocaine and alcohol) and criminal behaviors, probably due to a shared impulsivity core feature. Conclusions: Considering the shared symptoms such as impulsive and dangerous behaviors, in patients with only one disease, misdiagnosis is a common phenomenon due to the overlapping symptoms of ASPD and BD. It may be useful to recognize the co-occurrence of the disorders and better characterize the patient with ASPD and BD evaluating all dysfunctional aspects and their influence on core symptoms.

Art can often act as an entry point for conversations that can be difficult to engage in naturally and spontaneously. The National Academy of Medicine (NAM), a non-profit organization principally focused on solving pressing issues in health and medicine through traditional scientific methods, has recently begun to use art as a way to expand its impact and intentionally include underrepresented voices. Over the past 2 years, the NAM has launched two nationwide art projects aimed at sharing the lived experiences of people from across the United States and giving voice to the challenges they face. Visualize Health Equity asked communities to share their understanding and perceptions of health equity and its role in supporting the well-being of all people. Expressions of Clinician Well-Being called on artists to explore clinician well-being and its connection to quality patient care and a thriving health system. Together, these projects provide insights into the experiences of hundreds of people and contribute to a national dialogue on topics that are critical for the nation’s prosperity.