Bipolar I disorder with mood-incongruent psychotic symptoms

Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik, Martin-Luther-Universität Halle-Wittenberg, Halle 06097, Germany.
European Archives of Psychiatry and Clinical Neuroscience (Impact Factor: 3.53). 03/2009; 259(3):131-6. DOI: 10.1007/s00406-007-0790-7
Source: PubMed


The purpose of this paper is to demonstrate similarities and differences between bipolar I patients with and without mood-incongruent symptoms (MIS) over a long period of time, independently of longitudinal syndromatic constellations.
The Halle bipolarity longitudinal study (HABILOS) prospectively investigates 182 patients meeting the DSM-IV criteria for bipolar I disorders over a long period of time (x;- = 16.84 years). One thousand five hundred thirty-nine (1,539) episodes have been evaluated with standardized instruments. Patients and episodes were divided into two groups (with and without MIS) and were compared on various levels.
It was found: (1) The majority of the episodes of bipolar I patients during long-term course did not have MIS, but the majority of patients did. (2) Bipolar I patients with MIS differ from patients without MIS in the following features: (a) Bipolar I patients with MIS are more frequently males. (b) Bipolar I patients with MIS need treatment at a significantly younger age than those without MIS. (c) First manifestation of bipolar I disorder with MIS after the age of 50 is extremely seldom. (d) Bipolar I patients with MIS more frequently have relatives with schizophrenia. (e) Bipolar I patients with MIS more frequently become disabled and retire at a significantly younger age than patients without MIS and (f) Significantly fewer patients with MIS than those without MIS live in a stable partnership.
It can be concluded that bipolar I disorders with MIS are more severe disorders than bipolar I disorders without MIS. This finding in combination with the above results, however, can give rise to the conclusion that bipolar I disorders with MIS are the epiphenomenon of the overlap, possibly genetic, of a "schizophrenic spectrum" and a "bipolar spectrum" and their antagonistic influence creating a "schizo-affective" area between them as a kind of psychotic continuum between prototypes.

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