Long-Acting Aripiprazole in Comorbid Bipolar Disorder and Borderline Personality Disorder and Substance Abuse

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To the Editors
Bipolar disorder (BD) is an affective disorder characterized by distinctive episodes of depression and mania or hypomania with or without psychotic symptoms. Individuals with BD frequently experience other psychiatric disorders as well, such as borderline personality disorder (BPD).1 Borderline personality disorder is defined by a pervasive pattern of instability in interpersonal relationships, self-image, impulse control, and affect. In addition, comorbid substance abuse is very common in patients with mood or personality disorders.1,2 The presence of a comorbid condition influences the clinical course, as well as the choice of therapy for the patient.2 However, few controlled pharmacological studies have examined treatments for patients with 3 or more associated psychiatric disorders.
Aripiprazole is an atypical antipsychotic agent approved to treat schizophrenia and BD, although its efficacy has been proven in cases of BPD and substance abuse disorders.3–6 A long-acting injection (LAI) form of aripiprazole has also shown significant beneficial effects in patients with schizophrenia stabilized with oral aripiprazole,7 but there is a lack of data in the literature regarding this treatment in patients with other comorbid psychiatric disorders. We report a patient who received a diagnosis of comorbid bipolar and BPDs in addition to substance abuse, who experienced marked improvement after off-label prescription of aripiprazole LAI therapy.
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