Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Massachusetts General Hospital, Boston, MA, USA.
Bipolar Disord. 2018 Feb;20(1):18-26. doi: 10.1111/bdi.12527. Epub 2017 Aug 23.
Although there is a common clinical assumption that bipolar disorder with psychotic features reflects greater severity than bipolar disorder without psychosis, the existing empirical literature is mixed. This study investigated the phenomenology of psychosis as well as demographic, clinical, functional, and neuropsychological features in a large, cross-sectional sample of participants with bipolar disorder divided by history of psychosis.
In a large single study, 168 affective-only bipolar disorder (BP-A) participants and 213 bipolar disorder with a history of psychosis (BP-P) participants completed a comprehensive clinical diagnostic interview and neuropsychological testing. t tests, chi-square tests, and Bayes factors were used to investigate group differences or lack thereof.
The prevalence of psychosis in this sample (53%) was similar to published reports. Nearly half of BP-P participants experienced grandiose delusions, and relatively few endorsed "first-rank" hallucinations of running commentary or two or more voices conversing. There were no demographic or neuropsychological differences between groups. BP-A participants experienced greater chronicity of affective symptoms and a greater degree of rapid cycling than BP-P participants; there were no other clinical differences between groups.
Overall, these results contradict the conventional notion that bipolar disorder with psychotic features represents a more severe illness than bipolar disorder without a history of psychosis. The presence of psychosis does not appear to be associated with poorer clinical/functional outcome or suggest a greater degree of neuropsychological impairment; conversely, the absence of psychosis was associated with affective chronicity and rapid cycling. Nosological and treatment implications are discussed.
尽管临床上普遍认为伴有精神病特征的双相情感障碍比没有精神病的双相情感障碍更严重，但现有的实证文献却存在差异。本研究通过对有或无精神病病史的双相情感障碍患者进行横断面研究，探讨了精神病的表现以及人口统计学、临床、功能和神经心理学特征。
在一项大型的单中心研究中，168 名仅有情感障碍的双相情感障碍（BP-A）患者和 213 名有精神病病史的双相情感障碍（BP-P）患者完成了全面的临床诊断访谈和神经心理学测试。采用 t 检验、卡方检验和贝叶斯因子来研究组间差异或缺乏差异。
该样本中精神病的患病率（53%）与已发表的报告相似。BP-P 组近一半的患者出现夸大妄想，而相对较少的患者出现“一级”幻觉，如评论性幻听或两个或更多声音的对话。两组在人口统计学和神经心理学方面没有差异。BP-A 患者的情感症状慢性程度和快速循环的程度均高于 BP-P 患者；两组之间没有其他临床差异。
总的来说，这些结果与传统观念相矛盾，即伴有精神病特征的双相情感障碍比没有精神病病史的双相情感障碍更严重。精神病的存在似乎与较差的临床/功能结果无关，也不表明神经心理学损害程度更大；相反，没有精神病的存在与情感慢性和快速循环有关。讨论了分类学和治疗的意义。
