Symptoms of bipolar psychosis
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Symptoms of Bipolar Psychosis
Prevalence of Psychotic Symptoms in Bipolar Disorder
Psychotic symptoms are highly prevalent in individuals with bipolar disorder (BD). Studies indicate that over half of the patients with BD experience psychotic symptoms at some point in their lives, with a higher prevalence in bipolar type I compared to bipolar type II disorder 16. These symptoms are more frequently observed during manic or mixed episodes rather than depressive episodes 16.
Common Psychotic Symptoms in Bipolar Disorder
Delusions and Hallucinations
Delusions are the most common psychotic symptoms in BD, often surpassing hallucinations in frequency. These delusions can include grandiosity, persecution, and other false beliefs that are not grounded in reality 13. Hallucinations, although less common, also occur and can involve any of the senses, with auditory hallucinations being the most frequent 1.
Mood-Incongruent and Mood-Congruent Symptoms
Psychotic symptoms in BD can be mood-congruent or mood-incongruent. Mood-congruent psychotic symptoms align with the individual's mood state, such as grandiose delusions during mania. In contrast, mood-incongruent symptoms do not match the mood state and can include bizarre delusions or hallucinations that are unrelated to the individual's emotional state 19. Mood-incongruent symptoms are often associated with a poorer prognosis and greater severity of illness 19.
Cognitive Impairments
Patients with psychotic bipolar disorder often exhibit cognitive impairments, particularly in executive functioning and spatial working memory. These deficits are more pronounced in individuals with a history of psychosis compared to those without 4. Despite these impairments, general intellectual function may remain preserved 4.
Impact on Course and Outcome
Hospitalizations and Treatment
Psychotic symptoms in BD are linked to increased rates and durations of hospitalizations. Patients with psychotic features often require more intensive treatment, including the use of antipsychotic medications 18. These individuals also tend to have a higher frequency of agitation, anxiety, and hostility 1.
Socio-Demographic and Clinical Features
The presence of psychotic symptoms is associated with less favorable socio-demographic profiles, such as earlier age of onset and higher rates of comorbid substance use disorders 8. Additionally, these patients often experience more severe episodes and require more frequent hospitalizations and psychosocial rehabilitation 8.
Functional Outcomes
Despite the high prevalence of psychotic symptoms, their impact on functional outcomes varies. Some studies suggest that psychosis in BD does not significantly affect long-term functional outcomes, while others indicate a correlation with poorer psychosocial and vocational functioning 9. The severity and type of psychotic symptoms, such as mood-incongruent delusions, may influence these outcomes 9.
Conclusion
Psychotic symptoms are a common and significant aspect of bipolar disorder, particularly in bipolar type I. These symptoms, including delusions and hallucinations, can vary in their congruence with mood states and are associated with cognitive impairments and more severe clinical profiles. Understanding the prevalence and impact of these symptoms is crucial for effective management and treatment of bipolar disorder.
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Most relevant research papers on this topic
Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review
Psychotic symptoms are common in bipolar disorder patients, but their impact on the illness' course and outcome is not always negative.
Systematic Review
Very Rigorous JournalDimensions of Psychosis in Patients with Bipolar Mania as Measured by the Positive and Negative Syndrome Scale
Similar psychotic symptom domains, measured by the PANSS, are found in patients with bipolar mania and schizophrenia.
RCT
Large Human TrialPsychotic symptoms in patients with bipolar mania.
High rates of psychosis are found in patients with bipolar mania, with grandiosity, delusions, lack of judgment, and hostility being the most prominent symptoms.
RCTLarge Human TrialThe Neurocognitive Signature of Psychotic Bipolar Disorder
Psychotic bipolar disorder is associated with differential impairments in frontal/executive processing tasks, but deficits in attention, psychomotor speed, and memory are part of the broader disease phenotype in patients with bipolar disorder.
Observational Study
Rigorous Journal
Highly CitedEfficacy of cognitive‐behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study
Group cognitive-behavioral therapy (CBT) can improve symptoms and functional deficits in young patients at risk for serious mental illness presenting with subthreshold bipolar symptoms.
RCTLifetime and point prevalence of psychotic symptoms in adults with bipolar disorders: a systematic review and meta-analysis
The lifetime prevalence of psychotic symptoms in adults with bipolar disorders is 63% in type I and 22% in type II, with more studies needed for depressive and mixed episodes and community samples.
Meta-AnalysisRigorous JournalTransdiagnostic dimensions of psychosis in the Bipolar‐Schizophrenia Network on Intermediate Phenotypes (B‐SNIP)
Transdiagnostic symptom dimensions of psychosis are valid and useful, transcending traditional diagnostic boundaries of psychotic disorders and accurately predicting biotypes with greater accuracy than categorical DSM diagnoses.
Observational StudyHighly CitedLifetime presence of psychotic symptoms in bipolar disorder is associated with less favorable socio-demographic and certain clinical features.
Lifetime presence of psychotic symptoms in bipolar patients is associated with a worse socio-demographic and clinical profile.
Observational StudyRigorous JournalPsychosis in bipolar disorder: phenomenology and impact on morbidity and course of illness.
In this large cohort of bipolar I disorder patients, neither a history of psychosis nor mood-incongruent psychosis had prognostic significance at entry into the network.
Observational StudyHighly Cited