Marco Antonio Caldieraro1, Louisa G Sylvia2, Steven Dufour3, Samantha Walsh3, Jessica Janos3, Dustin J Rabideau4, Masoud Kamali2, Melvin G McInnis5, William V Bobo6, Edward S Friedman7, Keming Gao8, Mauricio Tohen9, Noreen A Reilly-Harrington2, Terence A Ketter10, Joseph R Calabrese8, Susan L McElroy11, Michael E Thase12, Richard C Shelton7, Charles L Bowden13, James H Kocsis14, Thilo Deckersbach2, Andrew A Nierenberg2. 1. Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. Electronic address: mcaldieraro@hcpa.edu.br. 2. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. 3. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. 4. Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA. 5. Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA. 6. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. 7. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 8. Mood Disorders Program, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA. 9. Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. 10. Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA USA. 11. Lindner Center of HOPE, Mason, OH, USA; Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 12. Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 13. Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA. 14. Department of Psychiatry, Weill Cornell Medical College, Ithaca, NY, USA.
Abstract
BACKGROUND: Psychotic bipolar depressive episodes remain remarkably understudied despite being common and having a significant impact on bipolar disorder. The aim of this study is to identify the characteristics of depressed bipolar patients with current psychosis compared to those without psychosis. METHODS: We used baseline data of a comparative effectiveness study of lithium and quetiapine for bipolar disorder (the Bipolar CHOICE study) to compare demographic, clinical, and functioning variables between those with and without psychotic symptoms. Of the 482 participants, 303 (62.9%) were eligible for the present study by meeting DSM-IV criteria for an acute bipolar depressive episode. Univariate analyses were conducted first, and then included in a model controlling for symptom severity. RESULTS: The sample was composed mostly of women (60.7%) and the mean age was 39.5±12.1 years. Psychosis was present in 10.6% (n=32) of the depressed patients. Psychotic patients had less education, lower income, and were more frequently single and unemployed. Psychosis was also associated with a more severe depressive episode, higher suicidality, more comorbid conditions and worse functioning. Most group differences disappeared when controlling for depression severity. LIMITATIONS: Only outpatients were included and the presence of psychosis in previous episodes was not assessed. CONCLUSION: Psychosis during bipolar depressive episodes is present even in an outpatient sample. Psychotic, depressed patients have worse illness outcomes, but future research is necessary to confirm if these outcomes are only associated with the severity of the disorder or if some of them are independent of it.
BACKGROUND:Psychotic bipolar depressive episodes remain remarkably understudied despite being common and having a significant impact on bipolar disorder. The aim of this study is to identify the characteristics of depressed bipolarpatients with current psychosis compared to those without psychosis. METHODS: We used baseline data of a comparative effectiveness study of lithium and quetiapine for bipolar disorder (the Bipolar CHOICE study) to compare demographic, clinical, and functioning variables between those with and without psychotic symptoms. Of the 482 participants, 303 (62.9%) were eligible for the present study by meeting DSM-IV criteria for an acute bipolar depressive episode. Univariate analyses were conducted first, and then included in a model controlling for symptom severity. RESULTS: The sample was composed mostly of women (60.7%) and the mean age was 39.5±12.1 years. Psychosis was present in 10.6% (n=32) of the depressedpatients. Psychotic patients had less education, lower income, and were more frequently single and unemployed. Psychosis was also associated with a more severe depressive episode, higher suicidality, more comorbid conditions and worse functioning. Most group differences disappeared when controlling for depression severity. LIMITATIONS: Only outpatients were included and the presence of psychosis in previous episodes was not assessed. CONCLUSION:Psychosis during bipolar depressive episodes is present even in an outpatient sample. Psychotic, depressedpatients have worse illness outcomes, but future research is necessary to confirm if these outcomes are only associated with the severity of the disorder or if some of them are independent of it.
Authors: Amit Shalev; John Merranko; Mary Kay Gill; Tina Goldstein; Fangzi Liao; Benjamin I Goldstein; Heather Hower; Neal Ryan; Michael Strober; Satish Iyengar; Martin Keller; Shirley Yen; Lauren M Weinstock; David Axelson; Boris Birmaher Journal: Bipolar Disord Date: 2019-12-17 Impact factor: 6.744
Authors: Kristin J Fredriksen; Margrethe A Schaufel; Jan O Johannessen; Fredrik A Walby; Larry Davidson; Helle K Schoeyen Journal: Psychiatr Q Date: 2020-03