Bipolar disorder with and without a history of psychotic features: fMRI correlates of sustained attention

The search for predictors of outcome has not been particularly rewarding, and the use of lithium remains empirical: a trial of lithium is the most powerful predictor of outcome. However, lithium is a highly specific treatment for bipolar disorder. In non-bipolar affective disorder, factors of interest are correlates of bipolar disorder: mood-congruent psychotic features, retarded-endogenous profile, cyclothymic personality, positive family history of bipolar illness, periodicity, and normality between episodes of illness.

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Risk of bipolar disorder and psychotic features in patients initially hospitalised with severe depression

Acta Neuropsychiatrica ◽

10.1017/neu.2014.42 ◽

2014 ◽

Vol 27 (2) ◽

pp. 113-118 ◽

Cited By ~ 9

Author(s):

Kimiya Nakamura ◽

Junichi Iga ◽

Naoki Matsumoto ◽

Tetsuro Ohmori

Keyword(s):

Bipolar Disorder ◽

Severe Depression ◽

Psychotic Symptoms ◽

Primary Disorder ◽

Icd 10 ◽

History Of ◽

Physical Diseases ◽

The Stability ◽

Psychotic Features ◽

Depressive Episodes

ObjectiveSevere depression may be a risk factor for diagnostic conversion into bipolar disorder (BD), and psychotic depression (PD) has been consistently associated with BD. The aims of the present study were to investigate the stability of the diagnosis of severe depression and the differences between PD and non-psychotic severe depression (non-PD), as well as to assess the effectiveness of electroconvulsive therapy (ECT).MethodsPatients who were hospitalised for severe depression (diagnosed according to ICD-10) both with and without psychotic symptoms (n=89; mean age=55.6 years, SD=13.9) from 2001 to 2010 were retrospectively assessed.ResultsBy the 75th month of follow-up assessments, 11(12.4%) patients had developed BD. Among these 11 converters, nine had developed BD within 1 year after admission. Only sub-threshold hypomanic symptoms were significantly related to developing BD. The number of depressive episodes and history of physical diseases were significantly increased in non-PD compared with PD patients, whereas ECT was significantly increased in PD compared with non-PD patients. There was a significant association between length of stay at the hospital and the number of days between admission and ECT.ConclusionSub-threshold hypomanic symptoms may represent a prodrome of BD or an indicator of an already manifest phenotype, especially in older patients, which suggests cautious use of antidepressants. In severe depression, non-PD may often occur secondary to physical diseases and patients may experience increased recurrences compared with PD patients, which may be a more ‘primary’ disorder and often requires ECT treatments. ECT is effective for severe depression regardless of the presence of any psychotic feature; the earlier ECT is introduced, the better the expected treatment outcome.

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A case of attempted bilateral self-enucleation in a patient with bipolar disorder

Mental Illness ◽

10.4081/mi.2017.7141 ◽

2017 ◽

Vol 9 (1) ◽

Author(s):

Hannah Muniz Castro ◽

John Alvarez ◽

Robert G. Bota ◽

Marc Yonkers ◽

Jeremiah Tao

Keyword(s):

Bipolar Disorder ◽

Surgical Repair ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Self Mutilation ◽

Intraocular Hemorrhage ◽

History Of ◽

The Right ◽

Psychotic Features ◽

Tomography Scan

Attempted and completed self-enucleation, or removal of one’s own eyes, is a rare but devastating form of self-mutilation behavior. It is often associated with psychiatric disorders, particularly schizophrenia, substance induced psychosis, and bipolar disorder. We report a case of a patient with a history of bipolar disorder who gouged his eyes bilaterally as an attempt to self-enucleate himself. On presentation, the patient was manic with both psychotic features of hyperreligous delusions and command auditory hallucinations of God telling him to take his eyes out. On presentation, the patient had no light perception vision in both eyes and his exam displayed severe proptosis, extensive conjunctival lacerations, and visibly avulsed extraocular muscles on the right side. An emergency computed tomography scan of the orbits revealed small and irregular globes, air within the orbits, and intraocular hemorrhage. He was taken to the operating room for surgical repair of his injuries. Attempted and completed self-enucleation is most commonly associated with schizophrenia and substance induced psychosis, but can also present in patients with bipolar disorder. Other less commonly associated disorders include obsessive-compulsive disorder, depression, mental retardation, neurosyphilis, Lesch-Nyhan syndrome, and structural brain lesions.

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Auditory processing deficits in bipolar disorder with and without a history of psychotic features

Bipolar Disorders ◽

10.1111/bdi.12333 ◽

2015 ◽

Vol 17 (7) ◽

pp. 769-780 ◽

Cited By ~ 4

Author(s):

RyAnna Zenisek ◽

Nicholas S Thaler ◽

Griffin P Sutton ◽

Erik N Ringdahl ◽

Joel S Snyder ◽

...

Keyword(s):

Bipolar Disorder ◽

Auditory Processing ◽

History Of ◽

Processing Deficits ◽

Psychotic Features

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Schizophrenia, schizoaffective disorder, bipolar disorder

Psychotic Disorders ◽

10.1093/med/9780190653279.003.0005 ◽

2020 ◽

pp. 38-45

Author(s):

Barrett Kern ◽

Sarah K. Keedy

Keyword(s):

Bipolar Disorder ◽

Schizoaffective Disorder ◽

Statistical Manual ◽

Diagnostic And Statistical Manual ◽

Mood Symptoms ◽

History Of ◽

Psychotic Features ◽

Specific Symptoms ◽

Psychotic Bipolar Disorder

Schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features include varying degrees of psychosis and mood symptoms. As such, these disorders may represent three points on a spectrum rather than three categorically distinct disorders. This chapter outlines the key role of psychosis in characterizing these disorders and reviews the conceptual history of this characterization as embodied in the different editions of the Diagnostic and Statistical Manual of Mental Disorders. The inherent practical and conceptual problems associated with a categorical system for these diagnoses and for defining psychosis symptoms are emphasized. Finally, specific symptoms and their qualitative and quantitative features are compared and contrasted among schizophrenia, schizoaffective disorder, and psychotic bipolar disorder.

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The characteristics of psychotic features in bipolar disorder

Psychological Medicine ◽

10.1017/s0033291718002854 ◽

2018 ◽

Vol 49 (12) ◽

pp. 2036-2048 ◽

Cited By ~ 5

Author(s):

Annet H. van Bergen ◽

Sanne Verkooijen ◽

Annabel Vreeker ◽

Lucija Abramovic ◽

Manon H. Hillegers ◽

...

Keyword(s):

Bipolar Disorder ◽

Childhood Maltreatment ◽

Linear Models ◽

Disease Onset ◽

Cross Sectional Study ◽

Psychotic Symptoms ◽

Type I ◽

Cross Sectional ◽

History Of ◽

Psychotic Features

AbstractBackgroundIn a large and comprehensively assessed sample of patients with bipolar disorder type I (BDI), we investigated the prevalence of psychotic features and their relationship with life course, demographic, clinical, and cognitive characteristics. We hypothesized that groups of psychotic symptoms (Schneiderian, mood incongruent, thought disorder, delusions, and hallucinations) have distinct relations to risk factors.MethodsIn a cross-sectional study of 1342 BDI patients, comprehensive demographical and clinical characteristics were assessed using the Structured Clinical Interview for DSM-IV (SCID-I) interview. In addition, levels of childhood maltreatment and intelligence quotient (IQ) were assessed. The relationships between these characteristics and psychotic symptoms were analyzed using multiple general linear models.ResultsA lifetime history of psychotic symptoms was present in 73.8% of BDI patients and included delusions in 68.9% of patients and hallucinations in 42.6%. Patients with psychotic symptoms showed a significant younger age of disease onset (β = −0.09, t = −3.38, p = 0.001) and a higher number of hospitalizations for manic episodes (F11 338 = 56.53, p < 0.001). Total IQ was comparable between groups. Patients with hallucinations had significant higher levels of childhood maltreatment (β = 0.09, t = 3.04, p = 0.002).ConclusionsIn this large cohort of BDI patients, the vast majority of patients had experienced psychotic symptoms. Psychotic symptoms in BDI were associated with an earlier disease onset and more frequent hospitalizations particularly for manic episodes. The study emphasizes the strength of the relation between childhood maltreatment and hallucinations but did not identify distinct subgroups based on psychotic features and instead reported of a large heterogeneity of psychotic symptoms in BD.

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Stroop-test interference in bipolar disorder

The British Journal of Psychiatry ◽

10.1192/bjp.bp.108.052639 ◽

2009 ◽

Vol 194 (3) ◽

pp. 285-286 ◽

Cited By ~ 20

Author(s):

Eugenia Kravariti ◽

Katja Schulze ◽

Fergus Kane ◽

Sridevi Kalidindi ◽

Elvira Bramon ◽

...

Keyword(s):

Bipolar Disorder ◽

Depressive Symptoms ◽

Family History ◽

Degree Relative ◽

Neuropsychological Screening ◽

First Degree Relatives ◽

Healthy Control ◽

History Of ◽

Psychotic Features ◽

Interference Score

SummaryWe analysed Stroop (neuropsychological screening test) measures of response inhibition in 18 twin pairs discordant for bipolar I disorder compared with 17 healthy control pairs, as well as 40 singletons with bipolar disorder with psychotic features and a family history of psychosis, 46 of their first-degree relatives without bipolar disorder or psychosis and 48 controls. In both studies, individuals with bipolar disorder showed Stroop deficits and their first-degree relatives showed intact performance. In the twin patients, an interference score was associated with depressive symptoms. Having a first-degree relative with bipolar disorder, even a familial, psychotic form, did not confer risk for enhanced susceptibility to interference in our studies.

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A case of attempted bilateral self-enucleation in a patient with bipolar disorder

Mental Illness ◽

10.1108/mi.2017.7141 ◽

2017 ◽

Vol 9 (1) ◽

pp. 20-22

Author(s):

Hannah Muniz Castro ◽

John Alvarez ◽

Robert G. Bota ◽

Marc Yonkers ◽

Jeremiah Tao

Keyword(s):

Bipolar Disorder ◽

Surgical Repair ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Self Mutilation ◽

Intraocular Hemorrhage ◽

History Of ◽

The Right ◽

Psychotic Features ◽

Tomography Scan

Attempted and completed self-enucleation, or removal of one's own eyes, is a rare but devastating form of self-mutilation behavior. It is often associated with psychiatric disorders, particularly schizophrenia, substance induced psychosis, and bipolar disorder. We report a case of a patient with a history of bipolar disorder who gouged his eyes bilaterally as an attempt to self-enucleate himself. On presentation, the patient was manic with both psychotic features of hyperreligous delusions and command auditory hallucinations of God telling him to take his eyes out. On presentation, the patient had no light perception vision in both eyes and his exam displayed severe proptosis, extensive conjunctival lacerations, and visibly avulsed extraocular muscles on the right side. An emergency computed tomography scan of the orbits revealed small and irregular globes, air within the orbits, and intraocular hemorrhage. He was taken to the operating room for surgical repair of his injuries. Attempted and completed self-enucleation is most commonly associated with schizophrenia and substance induced psychosis, but can also present in patients with bipolar disorder. Other less commonly associated disorders include obsessive-compulsive disorder, depression, mental retardation, neurosyphilis, Lesch-Nyhan syndrome, and structural brain lesions.

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Neuropsychological status of bipolar I disorder: impact of psychosis

The British Journal of Psychiatry ◽

10.1192/bjp.bp.108.052001 ◽

2009 ◽

Vol 194 (3) ◽

pp. 243-251 ◽

Cited By ~ 46

Author(s):

Jonathan Savitz ◽

Lize van der Merwe ◽

Dan J. Stein ◽

Mark Solms ◽

Rajkumar Ramesar

Keyword(s):

Bipolar Disorder ◽

Personality Traits ◽

Childhood Trauma ◽

Declarative Memory ◽

Type I ◽

Schizotypal Personality ◽

Neuropsychological Status ◽

History Of ◽

Psychotic Features ◽

The Impact

BackgroundThe presence of schizotypal personality traits in some people with bipolar disorder, together with reports of greater cognitive dysfunction in patients with a history of psychotic features compared with patients without such a history, raises questions about the nosological relationship between bipolar disorder with psychotic features and bipolar disorder without psychotic features.AimsTo test the impact of a history of DSM–IV-defined psychosis on the neuropsychological status of participants with bipolar disorder while statistically controlling for confounding factors such as mood, medication, alcohol misuse/dependence and childhood abuse, and to evaluate the impact of schizotypal personality traits (and thus potential vulnerability to psychotic illness) on the cognitive performance of people with bipolar disorder and their healthy relatives.MethodNeuropsychological data were obtained for 25 participants with type I bipolar disorder and a history of psychosis, 24 with type I bipolar disorder but no history of psychosis and 61 unaffected relatives. Schizotypal traits were measured with the Schizotypal Personality Scale (STA). Childhood trauma was measured with the Childhood Trauma Questionnaire.ResultsThe group with a history of psychosis performed significantly worse than the healthy relatives on measures of verbal working memory, cognitive flexibility and declarative memory. Nevertheless, the two bipolar disorder groups did not differ significantly from each other on any cognitive measure. Scores on the STA were negatively associated with verbal working and declarative memory, but positively associated with visual recall memory.Conclusions‘Psychotic’ and ‘non-psychotic’ subtypes of bipolar disorder may lie on a nosological continuum that is most clearly defined by verbal memory impairment.

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