Course of illness in psychotic mania: is mood incongruence important?
ABSTRACT Previous research is inconsistent regarding the significance of mood-incongruent psychotic symptoms in relation to the severity and course of bipolar disorder. In the present study, bipolar I patients were assessed at index hospitalization using standardized symptom measures and followed up to 28 months. We contrasted the symptomatic course in patients experiencing mood-congruent versus mood-incongruent psychotic symptoms. Results revealed that patients spent an average of 29% of the time during follow-up in a mood episode, but only 5% of the time with psychotic symptoms. Few differences were found at the index hospitalization and no differences were found on any longitudinal course variables between mood-congruence subtypes. Although experiencing high levels of psychosis at baseline, both subtypes improved considerably following hospitalization, and psychotic symptom levels remained relatively stable. Current results suggest that when provided efficacious treatment, mood-incongruent psychotic mania does not predict a worse symptomatic course of illness.
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ABSTRACT: There is general agreement that DSM-IV and ICD-10 require major improvements in format and content to make them more valid, evidence-based and clinically useful. DSM-IV-TR currently includes a series of clinical features that provide potentially useful information on cross-sectional and longitudinal courses of bipolar disorder. This conceptual and data-driven review proposes changes in the current classification by removing, modifying and adding bipolar episode and course specifiers in DSM-V. Specifiers to be maintained would be 'with catatonic features', 'with melancholic features', 'with atypical features' and 'with rapid cycling'. The 'seasonal pattern' modifier should be amended to allow manic, hypomanic and mixed episodes to be included in the description. Some specifiers should likely be substantially reconceptualized ('severity/psychosis/remission') or removed ('with post-partum onset'). Age at onset (early, intermediate or late onset) and predominant polarity (manic, depressive) should be added for their relevance for course and outcome.Psychopathology 06/2009; 42(4):209-18. DOI:10.1159/000218518 · 1.56 Impact Factor
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ABSTRACT: Bipolar disorder with psychosis is common in inpatient settings and is associated with diverse outcomes after hospital discharge, which can range from a return to premorbid functioning with no recurrence, to a chronic or recurring illness. Less is known, however, about factors that can predict a better or worse clinical outcome. The present study sought to assess four-year clinical outcomes and their predictors in patients hospitalized for bipolar I disorder with psychosis. Participants from the Suffolk County Mental Health Project (SCMHP) with a baseline diagnosis of bipolar I disorder with psychotic features (N=126) were reassessed using face-to-face interviews at six months, two years, and four years following their first hospitalization. At each time point, clinical status, role functioning, and treatment were assessed by highly trained interviewers using standardized instruments. The majority of participants (73.2%) returned to their premorbid level of role functioning by the four-year follow-up and the median percentage of time ill during the interval was less than 20%. Nevertheless, almost half of the sample (46.9%) was rehospitalized at least once. Psychotic symptoms at baseline (particularly Schneiderian symptoms), depressive phenomenology, childhood psychopathology, and younger age at first hospitalization predicted worse outcome, whereas mood-incongruent psychotic features and age of mood disorder onset did not. The four-year outcomes of a first-admission cohort with bipolar I disorder with psychosis were generally favorable. Poorer premorbid functioning, Schneiderian delusions, greater depressive symptoms, and a younger age of first hospitalization portend a worse course.Bipolar Disorders 02/2012; 14(1):19-30. DOI:10.1111/j.1399-5618.2012.00982.x · 4.89 Impact Factor
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ABSTRACT: Paranoia is commonly a mood-incongruent psychotic symptom of mania which may be related to dopamine dysregulation. Progesterone and its metabolite allopregnanolone (ALLO) have been found in animals to antagonize the effects of dopamine. We therefore examined serum progesterone, its endogenous antagonist DHEAS and polymorphisms of the genes coding for certain steroidogenetic enzymes (AKR1C4, HSD3B2, and SRD5A1) in 64 males and 96 females with bipolar 1 or 2 disorder with or without paranoid ideation during mood elevation. Euthymic morning serum progesterone, DHEAS and cortisol concentrations were measured in males and in premenopausal women who were in follicular phase and not taking oral contraceptives. In women only, SNPs in AKR1C4 reduced the likelihood of having exhibited paranoid ideation by circa 60%. The haplotype of all 4 SNPs in the AKR1C4 gene reduced the risk of exhibiting paranoia by 80% (OR 0.19, 95% CI 0.06-0.61, p=0.05). A history of paranoid ideation was not, however, related to progesterone or DHEAS concentration. Serum DHEAS and progesterone concentrations were lower in men who had shown paranoid ideation during mania/hypomania compared with those who had not (F=7.30, p=0.006) however this was not coupled to polymorphisms in the selected genes. The ancestral G in rs4659174 in HSD3B2 was in men associated with a lower risk of paranoid ideation (likelihood ratio χ(2) 3.97, p=0.046, OR 0.31 (95% CI 0.10-0.96)) but did not correlate with hormone concentrations. Hence, gene variants in the steroidogenetic pathway and steroids concentration differences may be involved in the susceptibility to paranoia during mood elevation.European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 02/2012; 22(9):632-40. DOI:10.1016/j.euroneuro.2012.01.007 · 5.40 Impact Factor