Dell'Osso Bernardo, Camuri Giulia, Cremaschi Laura, Dobrea Cristina, Buoli Massimiliano, Ketter Terence A, Altamura A Carlo
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.
Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Compr Psychiatry. 2017 Jul;76:169-176. doi: 10.1016/j.comppsych.2017.04.005. Epub 2017 Apr 21.
The presence of psychotic symptoms in bipolar disorder (BD) is considered a feature of higher severity of illness and, in particular, of manic episodes in bipolar I disorder (BD I). However, the possibility to apply the "with psychotic features" specifier to major depressive episodes in either bipolar II disorder (BD II) or BD I highlights the need for additional research in this area.
The present study assessed the lifetime presence of psychotic symptoms and related socio-demographic and clinical features in a large sample of BD patients (N=360), with (BDPs, N=207) and without a lifetime history of psychosis (BDNPs, N=153).
An overall less favorable socio-demographic profile was observed in BDPs vs BDNPs. In terms of clinical variables, BDPs vs BDNPs had: earlier age at onset (27.7±10.5 vs 30.1±12.3years; p=0.02), higher rates of BD I diagnosis (95.7% vs 45.8%; p<0.001), more elevated (manic/hypomanic/mixed) polarity of first (55.2% vs 24.4%; p<0.001) and most recent episode (69.8% vs 35.6%; p<0.001), more comorbid alcohol/substance use disorder (38.1% vs 21.9%; p=0.002), more lifetime hospitalizations (3.8±6.1 vs 2±3; p=0.002) and involuntary commitments (1±1.9 vs 0.1±0.4; p<0.001), more history of psychosocial rehabilitation (17.9% vs 5.7%; p=0.001), more current antipsychotic use (90.1% vs 70.9%; p<0.001), and lower GAF (62.3±14.2 vs 69.3±12.5; p<0.001), but shorter duration of most recent episode (34.1±45.4 vs 50.3±65.7days; p=0.04), lower rates of comorbid anxiety disorders (23.9% vs 38.2%; p=0.005), and antidepressant use (19.4% vs 56.6%; p<0.001).
The present findings indicate an overall worse profile of socio-demographic and certain clinical characteristics associated with the lifetime presence of psychotic symptoms in bipolar patients.
双相情感障碍（BD）中精神病性症状的存在被认为是疾病严重程度较高的一个特征，尤其是在双相I型障碍（BD I）的躁狂发作中。然而，在双相II型障碍（BD II）或BD I的重度抑郁发作中应用“伴有精神病性特征”这一说明符的可能性凸显了该领域进一步研究的必要性。
本研究评估了一大样本BD患者（N = 360）中精神病性症状的终生存在情况以及相关的社会人口学和临床特征，其中有精神病性症状的患者（BDPs，N = 207）和无精神病终生史的患者（BDNPs，N = 153）。
与BDNPs相比，BDPs的总体社会人口学特征更不理想。在临床变量方面，BDPs与BDNPs相比：发病年龄更早（27.7±10.5岁对30.1±12.3岁；p = 0.02），BD I诊断率更高（95.7%对45.8%；p<0.001），首次发作（55.2%对24.4%；p<0.001）和最近一次发作（69.8%对35.6%；p<0.001）的（躁狂/轻躁狂/混合）极性更高，共病酒精/物质使用障碍更多（38.1%对21.9%；p = 0.002），终生住院次数更多（3.8±6.1次对2±3次；p = 0.002）和非自愿住院次数更多（1±1.9次对0.1±0.4次；p<0.001），心理社会康复史更多（17.9%对5.7%；p = 0.001），当前使用抗精神病药物的比例更高（90.1%对70.9%；p<0.001），且总体功能评估（GAF）更低（62.3±14.2对69.3±12.5；p<0.001），但最近一次发作的持续时间更短（34.1±45.4天对50.3±65.7天；p = 0.04），共病焦虑障碍的发生率更低（23.9%对38.2%；p = 0.005），以及使用抗抑郁药的比例更低（19.4%对56.6%；p<0.
