|
1
|
Aminoff SR, Onyeka IN, Ødegaard M, Simonsen C, Lagerberg TV, Andreassen OA, Romm KL, Melle I. Lifetime and point prevalence of psychotic symptoms in adults with bipolar disorders: a systematic review and meta-analysis. Psychol Med 2022; 52:2413-2425. [PMID: 36016504 PMCID: PMC9647517 DOI: 10.1017/s003329172200201x] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/14/2022] [Accepted: 06/14/2022] [Indexed: 12/24/2022]
Abstract
Psychotic symptoms, that we defined as delusions or hallucinations, are common in bipolar disorders (BD). This systematic review and meta-analysis aims to synthesise the literature on both lifetime and point prevalence rates of psychotic symptoms across different BD subtypes, including both BD type I (BDI) and BD type II (BDII). We performed a systematic search of Medline, PsycINFO, Embase and Cochrane Library until 5 August 2021. Fifty-four studies (N = 23 461) of adults with BD met the predefined inclusion criteria for evaluating lifetime prevalence, and 24 studies (N = 6480) for evaluating point prevalence. Quality assessment and assessment of publication bias were performed. Prevalence rates were calculated using random effects meta-analysis, here expressed as percentages with a 95% confidence interval (CI). In studies of at least moderate quality, the pooled lifetime prevalence of psychotic symptoms in BDI was 63% (95% CI 57.5-68) and 22% (95% CI 14-33) in BDII. For BDI inpatients, the pooled lifetime prevalence was 71% (95% CI 61-79). There were no studies of community samples or inpatient BDII. The pooled point prevalence of psychotic symptoms in BDI was 54% (95 CI 41-67). The point prevalence was 57% (95% CI 47-66) in manic episodes and 13% (95% CI 7-23.5) in depressive episodes. There were not enough studies in BDII, BDI depression, mixed episodes and outpatient BDI. The pooled prevalence of psychotic symptoms in BDI may be higher than previously reported. More studies are needed for depressive and mixed episodes and community samples.Prospero registration number: CRD 42017052706.
Collapse
Affiliation(s)
- S. R. Aminoff
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - I. N. Onyeka
- Department of Psychology, Sociology & Politics, Sheffield Hallam University, Sheffield, UK
| | - M. Ødegaard
- University of Oslo Library, University of Oslo, Oslo, Norway
| | - C. Simonsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - T. V. Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - O. A. Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - K. L. Romm
- Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - I. Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
|
2
|
Chakrabarti S, Singh N. Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review. World J Psychiatry 2022; 12:1204-1232. [PMID: 36186500 PMCID: PMC9521535 DOI: 10.5498/wjp.v12.i9.1204] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/02/2022] [Accepted: 08/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.
AIM To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.
METHODS The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.
RESULTS This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.
CONCLUSION Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.
Collapse
Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
| | - Navdeep Singh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
| |
Collapse
|
|
3
|
Altamura AC, Buoli M, Cesana BM, Fagiolini A, de Bartolomeis A, Maina G, Bellomo A, Dell'Osso B. Psychotic versus non-psychotic bipolar disorder: Socio-demographic and clinical profiles in an Italian nationwide study. Aust N Z J Psychiatry 2019; 53:772-781. [PMID: 30658550 DOI: 10.1177/0004867418823268] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Psychotic versus non-psychotic patients with bipolar disorder have been traditionally associated with different unfavorable clinical features. In this study on bipolar Italian patients, we aimed to compare clinical and demographic differences between psychotic and non-psychotic individuals, exploring clinical factors that may favor early diagnosis and personalized treatment. METHODS A total of 1671 patients (males: n = 712 and females: n = 959; bipolar type 1: n = 1038 and bipolar type 2: n = 633) from different psychiatric departments were compared according to the lifetime presence of psychotic symptoms in terms of socio-demographic and clinical variables. Chi-square tests for qualitative variables and Student's t-tests for quantitative variables were performed for group comparison, and a multivariable logistic regression was performed, considering the lifetime psychotic symptoms as dependent variables and socio-demographic/clinical characteristics as independent variables. RESULTS Psychotic versus non-psychotic bipolar subjects resulted to: be more frequently unemployed (p < 0.01) and never married/partnered (p < 0.01); have an earlier age at onset (p < 0.01); more frequently receive a first diagnosis different from a mood disorder (p < 0.01); have a shorter duration of untreated illness (p < 0.01); have a more frequently hypomanic/manic prevalent polarity (p < 0.01) and a prevalent manic-depressive type of cycling (p < 0.01); present a lower lifetime number of depressive episodes (p < 0.01), but have more manic episodes (p < 0.01); and less insight (p < 0.01) and more hospitalizations in the last year (p < 0.01). Multivariable regression analysis showed that psychotic versus non-psychotic bipolar patients received more frequently a first diagnosis different from bipolar disorder (odds ratio = 0.64, 95% confidence interval = [0.46, 0.90], p = 0.02) or major depressive disorder (odds ratio = 0.66, 95% confidence interval = [0.48, 0.91], p = 0.02), had more frequently a prevalent manic polarity (odds ratio = 1.84, 95% confidence interval = [1.14, 2.98], p < 0.01) and had a higher number of lifetime manic episodes (more than six) (odds ratio = 8.79, 95% confidence interval = [5.93, 13.05], p < 0.01). CONCLUSION Lifetime psychotic symptoms in bipolar disorder are associated with unfavorable socio-demographic and clinical features as well as with a more frequent initial misdiagnosis.
Collapse
Affiliation(s)
- Alfredo Carlo Altamura
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimiliano Buoli
- 1 Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Bruno Mario Cesana
- 2 Unit of Biostatistics and Biomathematics, University of Brescia, Brescia, Italy.,3 Department of Clinical Sciences and Community Health, Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro", Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Andrea Fagiolini
- 4 Department of Mental Health and Department of Molecular Medicine, University of Siena Medical Center, Siena, Italy
| | - Andrea de Bartolomeis
- 5 Section of Psychiatry and Laboratory of Molecular and Translational Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Giuseppe Maina
- 6 Department of Mental Health, San Luigi-Gonzaga Hospital, University of Turin, Turin, Italy
| | - Antonello Bellomo
- 7 Psychiatry Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy
| | - Bernardo Dell'Osso
- 8 Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,9 CRC 'Aldo Ravelli' for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy.,10 UOC Psichiatria 2, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy.,11 Department of Biomedical and Clinical Sciences "Luigi Sacco", Psychiatry Unit 2, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | | |
Collapse
|
|
4
|
Highton-Williamson E, Priebe S, Giacco D. Online social networking in people with psychosis: A systematic review. Int J Soc Psychiatry 2015; 61:92-101. [PMID: 25381145 DOI: 10.1177/0020764014556392] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Online social networking might facilitate the establishment of social contacts for people with psychosis, who are often socially isolated by the symptoms and consequences of their disorder. AIMS We carried out a systematic review exploring available evidence on the use of online social networking in people with psychosis. METHODS The review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies examined the use of the online social networking by people with an a priori diagnosis of psychosis (inclusive of bipolar disorder). Data from included studies were extracted and narratively synthesised. RESULTS A total of 11 studies, published between 2005 and 2013, reported data on online social networking in people with psychosis. People with psychosis seem to spend more time in chat rooms or playing online games than control groups. The use of other online tools, such as Facebook or communication through e-mail, is lower or the same than controls. Online social networking was used by patients with psychosis for establishing new relationships, maintaining relationships/reconnecting with people and online peer support. CONCLUSION Online social networking, in the form of forums or online chats, could play a role in strategies aimed at enhancing social networks and reduce the risk of isolation in this population.
Collapse
Affiliation(s)
- Elizabeth Highton-Williamson
- Unit for Social and Community Psychiatry (World Health Organization Collaborating Centre for Mental Health Services Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (World Health Organization Collaborating Centre for Mental Health Services Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
| | - Domenico Giacco
- Unit for Social and Community Psychiatry (World Health Organization Collaborating Centre for Mental Health Services Development), Newham Centre for Mental Health, Queen Mary University of London, London, UK
| |
Collapse
|
|
5
|
Østergaard SD, Bille J, Søltoft-Jensen H, Lauge N, Bech P. The validity of the severity-psychosis hypothesis in depression. J Affect Disord 2012; 140:48-56. [PMID: 22381953 DOI: 10.1016/j.jad.2012.01.039] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 01/25/2012] [Accepted: 01/26/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Psychotic depression (PD) is classified as a subtype of severe depression in the current diagnostic manuals. Accordingly, it is a common conception among psychiatrists that psychotic features in depression arise as a consequence of depressive severity. The aim of this study was to determine whether the severity of depressive and psychotic symptoms correlate in accordance with this "severity-psychosis" hypothesis and to detect potential differences in the clinical features of PD and non-psychotic depression (non-PD). METHODS Quantitative analysis of Health of the Nation Outcome Scales (HoNOS) scores from all patients admitted to a Danish general psychiatric hospital due to a severe depressive episode in the period between 2000 and 2010 was performed. RESULTS A total of 357 patients with severe depression, of which 125 (35%) were of the psychotic subtype, formed the study sample. Mean HoNOS scores at admission differed significantly between patients with non-PD and PD on the items hallucinations and delusions (non-PD=0.33 vs. PD=1.37, p<0.001), aggression (non-PD=0.20 vs. PD=0.36, p=0.044) and on the total score (non-PD=10.55 vs. PD=11.87, p=0.024). The HoNOS scores on the two items "depression" and "hallucinations and delusions" were very weakly correlated. LIMITATIONS Diagnoses were based on normal clinical practice and not formalized research criteria. CONCLUSIONS The symptomatology of PD and non-PD differs beyond the mere psychosis. Furthermore, severity ratings of depressive and psychotic symptoms are very weakly correlated. These findings offer further support to the hypothesis stating that the psychotic- and non-psychotic subtypes of depression may in fact be distinct clinical syndromes.
Collapse
Affiliation(s)
- Søren Dinesen Østergaard
- Unit For Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Mølleparkvej 10, 9000 Aalborg, Denmark.
| | | | | | | | | |
Collapse
|
|
6
|
Azorin JM, Kaladjian A, Adida M, Fakra E, Hantouche E, Lancrenon S. Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients. Eur Psychiatry 2011; 27:557-62. [PMID: 21292450 DOI: 10.1016/j.eurpsy.2010.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/09/2010] [Accepted: 11/13/2010] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition. METHODS One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics. RESULTS Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year. CONCLUSION In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.
Collapse
Affiliation(s)
- J M Azorin
- SHU psychiatrie adultes, hôpital Sainte-Marguerite, Assistance publique-Hôpitaux de Marseille, 13274 Marseille cedex 9, France.
| | | | | | | | | | | |
Collapse
|
|
7
|
Abstract
PURPOSE OF REVIEW Bipolar disorder is a complex clinical entity that presents with pleomorphic signs and symptoms varying from depression to hypomania, full-blown mania, mixed states, and psychosis. Therefore, the assessment of patients with bipolar disorder poses a difficult challenge to clinicians, who may find themselves puzzled when having to choose among the many instruments available. This paper aims at briefly reviewing these instruments. RECENT FINDINGS Observer-rated and self-completed instruments for the assessment of depressive, manic, and psychotic symptoms in patients with bipolar disorder are described with emphasis on topics of increasing interest in recent times, such as the assessment of bipolar depression, self-rating of manic symptoms, daily mood monitoring, screening, and early recognition of bipolar disorder. SUMMARY The use of standardized assessment instruments has many advantages as it enables clinicians to be more systematic and it allows greater precision, increased sensitivity to change, and opportunity to identify longitudinal patterns. Knowledge of available options for the assessment of patients with bipolar disorder may help clinicians and researchers to choose the most appropriate instruments for their specific needs.
Collapse
|
|
8
|
Toward the delineation of mania subtypes in the French National EPIMAN-II Mille Cohort. Comparisons with prior cluster analytic investigations. Eur Arch Psychiatry Clin Neurosci 2008; 258:497-504. [PMID: 18574610 DOI: 10.1007/s00406-008-0823-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 04/15/2008] [Indexed: 01/30/2023]
Abstract
BACKGROUND Knowledge about psychopathologic presentations of mania in current clinical practice has to be refined in order to improve diagnosis and treatment. METHODS One thousand ninety manic patients included in the French National Study EPIMAN-II Mille were submitted to a cluster analysis on the basis of multiple variables related to the history of bipolar illness and symptoms of the current episode. RESULTS Four clusters were identified: "classic mania" (29.3% of patients) with less severe mania; "psychotic mania" (22.7%) with psychotic symptoms, more severe mania, younger age and social impairment; "depressive mania" (30.4%) characterized by female gender, suicide attempts, high number of previous episodes and residual symptoms; and "dual mania" (17.6%) characterized by male gender, substance use, earlier onset and poor compliance. Patients groups also differed in manic symptoms, marital status, stressors preceding illness onset, prior diagnoses, first episode polarity and temperamental characteristics. LIMITATIONS Cross-sectional assessment of patients. CONCLUSIONS In comparing our findings with those of four prior cluster analytic studies, we integrate clinical characteristics of mania subtypes found in this very large representative French sample in contemporary practice, we suggest how such convergence of data may help improve earlier recognition, differential response to different treatments, and prevention of these subtypes. We finally suggest that such subtyping might provide clues to phenotype delineation suitable for pharmacogenetic investigations.
Collapse
|
|
9
|
Canuso CM, Bossie CA, Zhu Y, Youssef E, Dunner DL. Psychotic symptoms in patients with bipolar mania. J Affect Disord 2008; 111:164-9. [PMID: 18378001 DOI: 10.1016/j.jad.2008.02.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 02/11/2008] [Accepted: 02/12/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychosis has been identified in as many as 68% of patients with bipolar mania. This analysis identified psychotic symptoms in these patients. METHODS Data were from two placebo-controlled, 3-week studies in patients with an acute episode of bipolar mania. Symptoms were identified by the 30-item Positive and Negative Syndrome Scale (PANSS; item ratings, 1 = absent to 7 = extremely severe), the Young Mania Rating Scale, and the Global Assessment Scale. RESULTS Psychotic features at study entry were diagnosed in 264 (51.3%) of the 515 patients. At baseline, these patients had significantly more severe scores on the PANSS, Young Mania Rating Scale, and Global Assessment Scale than patients without psychotic features. Patients with psychotic features had mean (+/-SD) scores of mild (3) or greater on six PANSS items: grandiosity (4.5+/-1.4), delusions (4.4+/-1.4), lack of judgment/insight (4.1+/-1.5), excitement (3.9+/-1.3), suspiciousness/persecution (3.1+/-1.6), and hostility (3.1+/-1.5). Grandiosity symptoms of delusional proportions (scores > or = 4) were noted in 205 (78%) of patients with a diagnosis of psychotic features and in 113 (45%) patients without the diagnosis. LIMITATIONS The study was not specifically designed to assess patients with psychotic features and the PANSS was developed to evaluate symptoms of schizophrenia. CONCLUSIONS These findings support prior reports indicating high rates of psychosis in patients with bipolar mania and identify the most prominent symptoms in these patients.
Collapse
Affiliation(s)
- Carla M Canuso
- Ortho-McNeil Janssen Scientific Affairs, L.L.C., Titusville, New Jersey 08560, United States.
| | | | | | | | | |
Collapse
|
|
10
|
Abstract
INTRODUCTION Despite numerous explanatory hypotheses, few studies have involved a large national clinical sample examining risk factors in the occurrence of rapid cycling during the course of bipolar illness. METHODS From 1,090 manic bipolar I disorder inpatients included in a multicenter national study in France, 958 could be classified as rapid or nonrapid cyclers and assessed for demographic, illness course, clinical, psychometric, temperament, comorbidity, and treatment characteristics. RESULTS Rapid cycling bipolar disorder occurred in 9% (n=86) of the study group. Compared to nonrapid cyclers (n=872), patients with rapid cycling experienced the onset of their illness at a younger age, a higher number of prior episodes, more depression during the first episode, and more suicide attempts. At study entry, they also experienced manic episodes with more depressive and anxious symptoms, but less psychotic features. The following independent variables were associated with rapid cycling: longer duration of illness, antidepressant treatment, episodes with no free intervals, cyclothymic temperament, lower scores on the Scale for Assessment of Positive Symptoms and presence of thyroid disorder. Retrospective study limited to bipolar I disorder inpatients; several factors previously associated with rapid cycling were not assessed. CONCLUSION Our findings may confirm previous descriptions, according to which rapid cycling develops later in the course of illness following a sensitization process triggered by antidepressant use or thyroid dysfunction, in patients with a depression-mania-free interval course, and cyclothymic temperament.
Collapse
|
|
11
|
|
|
12
|
Freudenreich O, Holt DJ, Cather C, Goff DC. The evaluation and management of patients with first-episode schizophrenia: a selective, clinical review of diagnosis, treatment, and prognosis. Harv Rev Psychiatry 2007; 15:189-211. [PMID: 17924256 DOI: 10.1080/10673220701679804] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients who present with a first episode of psychosis pose many challenges to psychiatry. While some morbidity from schizophrenia is probably not modifiable once acute psychosis has occurred, the best management of this stage of illness nevertheless holds the promise of improving long-term outcomes. We review the clinical literature on first-episode psychosis to derive clinical guidance with regard to timely diagnosis and optimal pharmacological and nonpharmacological treatment. We describe the illness course and the prognosis for this acute phase of illness and the immediate, postpsychotic period.
Collapse
Affiliation(s)
- Oliver Freudenreich
- The Department of Psychiatry, Harvard Medical School, Schizophrenia Program, Massachusetts General Hospital, Boston, MA 02114, USA.
| | | | | | | |
Collapse
|
|
13
|
Azorin JM, Kaladjian A, Akiskal HS, Hantouche EG, Duchêne LC, Gury C, Lancrenon S. Validation of a severity threshold for the Mania Rating Scale: a receiver-operating characteristic analysis. Psychopathology 2007; 40:453-60. [PMID: 17709976 DOI: 10.1159/000107430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2006] [Accepted: 11/23/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to determine a cutoff score on the Mania Rating Scale (MRS), which easily allows identification of severe mania in a population of manic patients to be included in clinical trials of antimanic drugs. METHOD 1,090 hospitalized patients meeting DSM-IV criteria for a manic episode were subtyped according to the specifier for severity and assessed for demographic characteristics, illness course and clinical symptomatology. Using receiver-operating characteristic (ROC) analysis, the optimal threshold for severity was determined on the MRS. RESULTS In a French national clinical sample (n = 1,090), 851 cases were specified as severe and 239 as nonsevere (mild + moderate) mania according to DSM-IV criteria (307 without psychotic features, 544 with psychotic features). Patients with severe mania scored higher on the MRS but showed the same levels of scores on the Montgomery Asberg Depression Rating Scale compared to nonsevere cases. Many characteristics of the whole sample and of the psychotic group were found to be comparable, respectively, to those reported in recent epidemiological studies, which was particularly true for age, gender, age at onset, number of mood episodes and suicide attempts. The optimal ROC solution for separating severe from nonsevere mania was a cutoff score of 39 on the MRS. This cutoff score displayed a positive predictive value of 0.91. CONCLUSION A cutoff score of 39 is proposed as a severity threshold for mania on the MRS by virtue of its ROC validation in a large representative sample of severe versus nonsevere manic patients whose severity was assessed according to DSM-IV subtyping.
Collapse
Affiliation(s)
- Jean-Michel Azorin
- Sainte Marguerite Hospital, University of Marseilles, Marseilles, France.
| | | | | | | | | | | | | |
Collapse
|