MedWire News: Bipolar disorder patients who have psychotic features have a worse prognosis and response to lithium monotherapy than patients without such features, the results of a Turkish study indicate.

It has previously been suggested that up to 50% of bipolar disorder patients in an acute manic episode have psychosis, with rates in child and adolescent patients higher than those seen in adult patients. However, the impact of psychotic symptoms on prognosis and clinical course has rarely been investigated.

I Özyildirim, from Ünye State Hospital in Ordu, and colleagues therefore studied 97 bipolar I disorder patients who had suffered from the condition for at least 4 years and had at least three mood episodes, comparing the clinical features and response to long-term prophylaxis between those with and without psychosis.

The results, published in the journal European Psychiatry, indicate that 43 patients were psychotic in all mood episodes, while 54 had never experienced psychotic symptoms.

There were no significant differences between the psychotic and non-psychotic groups in terms of age, gender distribution, age of onset, and cycling interval. A family history of bipolar disorder was significantly more common in the non-psychotic than psychotic group, at 29.6% versus 11.6%.

Non-psychotic patients were also significantly more likely to have a predominantly depressive episode type than psychotic patients, at 25.0% versus 5.0%, and were significantly less likely to having a predominantly manic/mixed episode type, at 68.8% versus 85.0%.

Psychotic patients were significantly more likely to have severe mood episodes and had significantly more hospitalizations than non-psychotic patients, at 100% versus 27.8% and 1.9 versus 1.4, respectively.

Psychotic patients were significantly less likely to have a response to lithium monotherapy and more likely to have a response to anticonvulsant plus antipsychoctic therapy than non-psychotic patients, at 43.3% versus 89.7% and 100% versus 55.6%, respectively.

The team concludes: “Determination of psychotic subtype might be predictive for the clinical course of illness and establishing the optimum prophylactic treatment.”

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