Psychosis not associated with worse outcomes in bipolar disorder

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The results do not support the notion that bipolar disorder with psychotic features represents a more severe illness than bipolar disorder without a history of psychosis.
The results do not support the notion that bipolar disorder with psychotic features represents a more severe illness than bipolar disorder without a history of psychosis.

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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