Bipolar 1 disorder with psychotic features
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Bipolar I Disorder with Psychotic Features: An Overview
Prevalence and Types of Psychotic Features in Bipolar I Disorder
Bipolar I Disorder (BDI) is frequently accompanied by psychotic features, with a significant portion of patients experiencing these symptoms at some point in their lives. Studies indicate that approximately 73.8% of BDI patients report a lifetime history of psychotic symptoms, including delusions (68.9%) and hallucinations (42.6%) . These psychotic features can manifest during both manic and depressive episodes, with grandiose delusions being particularly common during manic phases 67.
Impact of Psychotic Features on Disease Course and Severity
Psychotic features in BDI are associated with a more severe disease course. Patients with psychotic symptoms tend to have an earlier onset of the disorder and a higher number of hospitalizations, especially for manic episodes . Additionally, mood-incongruent psychotic features, which do not align with the patient's mood state, are linked to increased rates of hospitalization and suicide attempts, suggesting a more severe form of the illness 24.
Neurocognitive Impairments in Psychotic Bipolar Disorder
Psychotic BDI patients exhibit distinct neurocognitive impairments compared to those without psychosis. These patients show significant deficits in executive functioning and spatial working memory, despite having preserved general intellectual function. They also experience moderate to severe impairments in attention, psychomotor speed, and memory, which are part of the broader disease phenotype in BDI .
Genetic and Familial Links
There is evidence to suggest that mood-incongruent psychotic features in BDI may have a genetic basis. Familial aggregation studies indicate that mood-incongruent psychosis is more likely to occur in relatives of BDI patients with these features. Genetic linkage analyses have identified suggestive associations with chromosomal regions 13q21-33 and 2p11-q14, which are also implicated in schizophrenia, highlighting potential shared genetic susceptibility between the two disorders 29.
Neuroanatomical Correlates
Neuroimaging studies have identified specific gray matter volume (GMV) deficits in psychotic BDI patients. These deficits are primarily located in the prefronto-temporal and cingulate cortices, precentral gyrus, and insula. These findings suggest that psychosis in BDI is associated with distinct cortical GMV reductions, which may contribute to the observed neurocognitive impairments .
Conclusion
Psychotic features in Bipolar I Disorder are prevalent and significantly impact the disease course, severity, and neurocognitive functioning. These features are associated with earlier onset, higher hospitalization rates, and specific neuroanatomical and genetic markers. Understanding these aspects is crucial for developing targeted interventions and improving outcomes for patients with psychotic BDI.
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