M Arrasate1, I González-Ortega2, S Alberich2, M Gutierrez2, M Martínez-Cengotitabengoa2, F Mosquera3, N Cruz4, M A González-Torres1, C Henry5, A González-Pinto6. 1. Department of Psychiatry, Basurto Hospital, EHU/UPV, Bilbao, Spain. 2. CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain. 3. CIBERSAM, Araba Mental Health, Vitoria-Gasteiz, Spain. 4. CIBERSAM, EMBREC, Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, Barcelona, Spain. 5. EMBREC, Department of Psychiatry, Paris, France. 6. CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain. Electronic address: anamaria.gonzalez-pintoarrillaga@osakidetza.net.
Abstract
OBJECTIVE: To examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years' follow-up. METHOD: Affective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or "other psychosis". The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed. RESULTS: Manic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. "other psychosis". Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio=1.383; 95% confidence interval, 1.205-1.587; P=0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis. CONCLUSION: The activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.
OBJECTIVE: To examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years' follow-up. METHOD: Affective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or "other psychosis". The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed. RESULTS:Manic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. "other psychosis". Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio=1.383; 95% confidence interval, 1.205-1.587; P=0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis. CONCLUSION: The activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.