Psychosis Not Associated With Bipolar Disorder Severity

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Most participants with a history of psychosis experienced delusions, and nearly half experienced grandiose delusions.
Most participants with a history of psychosis experienced delusions, and nearly half experienced grandiose delusions.

The presence of psychosis in patients with bipolar disorder was not associated with worse clinical or functional outcomes, according to a study recently published in Bipolar Disorders.

To determine the extent to which psychosis affects the severity of bipolar disorder, researchers recruited adults with bipolar disorder (n = 381) to undergo clinical and functional testing. The Diagnostic Interview for Genetic Studies (DIGS) was used to categorize participants as having affective-only bipolar disorder or bipolar disorder with a history of psychosis.

Clinical outcomes were evaluated with the DIGS, and functional outcomes were evaluated with neuropsychological testing to analyze auditory memory, visual memory, fine motor skill, emotion processing, and 4 domains of executive functioning: verbal fluency and processing speed, processing speed with interference resolution, conceptual reasoning and set-shifting, and inhibitory control.

A total of 53% of the study participants had a confirmed history of psychosis, which is in line with the data from other published reports, according to the study authors. Most participants with a history of psychosis experienced delusions,  and nearly half experienced grandiose delusions.

No significant demographic differences were noted between the patients with and those without psychosis (all P >.15). Similarly, the rates of history of mixed episodes, history of suicidal thoughts or behaviors, chronicity of substance abuse, functional effect of illness, and first-degree family history of bipolar disorder did not differ significantly between the 2 groups (all P >.07). For the 8 neuropsychological domains, no significant differences were noted between the participants with and those without psychosis (all P >.06).

The chronicity of affective symptoms was greater (P =.003) and the degree of rapid cycling was greater (P =.03) in the participants with affective-only bipolar disorder than in the participants with psychosis.

The study authors concluded that the "results do not support the clinical and anecdotal notion that [bipolar disorder] with psychotic features represents a more 'severe' illness than [bipolar disorder] without a history of psychosis."

Reference

Burton CZ, Ryan KA, Kamali M, et al. Psychosis in bipolar disorder: Does it represent a more “severe” illness [published online August 23, 2017]. Bipolar Disord. doi: 10.1111/bdi.12527

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