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Prevalence and description of psychotic features in bipolar mania

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Abstract

Psychotic symptoms are common in both the manic and depressive phases of bipolar disorder. More than half of patients with bipolar disorder will experience psychotic symptoms in their lifetime. Grandiose delusions are the most common type of psychotic symptom, but any kind of psychotic symptom, including thought disorder, hallucinations, mood-incongruent psychotic symptoms, and catatonia can present as part of a manic episode. Psychotic symptoms suggest poor prognosis when they occur in the absence of affective symptoms. However, psychotic symptoms can mask affective symptoms and make the distinction between manic-depressive illness and other psychiatric disorders difficult, especially in minorities. Careful assessment of prior psychiatric history, family history, and treatment response can aid in the differentiation of affective disorders with psychotic features from psychotic disorders.

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References and Recommended Reading

  1. KraepelinE: Psychiatrie. Ein Lehrbuch fur Studirende und Aerzte, edn 8. Leipzig: JA Barth; 1896.

    Google Scholar 

  2. Cooper JE, Kendell RE, Gulrand BJ, et al.: Psychiatric Diagnosis in New York and London: A Comparative Study of Mental Hospital Admissions. Institute of Psychiatry, Maudsley Monographs, No. 20.London: Oxford University Press; 1972.

    Google Scholar 

  3. McElroy SL, Keck PE Jr, Strakowski SM: Mania, psychosis and antipsychotics. J Clin Psychiatry 1996, 57(Suppl 3):14–26.

    PubMed  Google Scholar 

  4. Goodwin FK, Jamison KR:Manic Depressive Illness. New York: Oxford University Press; 1990.

    Google Scholar 

  5. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3. Washington, DC: American Psychiatric Press; 1980.

    Google Scholar 

  6. American Psychiatric Association:Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Press; 1994.

    Google Scholar 

  7. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3, revised. Washington, DC: American Psychiatric Press; 1987.

    Google Scholar 

  8. AndreasenNC: Thought, language, and communication disorders: II. Diagnostic significance. Arch Gen Psychiatry 1979, 36:1325–1330.

    PubMed  CAS  Google Scholar 

  9. AndreasenNC: Thought, language, and communication disorders: I. Clinical assessment, definition of terms, and evaluation of their reliability. Arch Gen Psychiatry 1979, 36:1313–1321.

    Google Scholar 

  10. Jampala VC, Taylor MA, Abrams R: The diagnostic implications of formal thought disorder in mania and schizophrenia: a reassessment. Am J Psychiatry 1989, 146:459–463.

    PubMed  CAS  Google Scholar 

  11. Kufferle B, Lenz G, Schanda H: Clinical evaluation of language and thought disorders in patients with schizophrenic and affective psychoses. Psychopathology 1985, 18:126–132.

    PubMed  CAS  Google Scholar 

  12. Earle-Boyer EA, Levinson JC, Grant R, Harvey PD: The consistency of thought disorder in mania and schizophrenia. II. An assessment at consecutive admissions. J Nerv Ment Dis 1986, 174:443–447.

    Article  PubMed  CAS  Google Scholar 

  13. Simpson DM, Davis GC: Measuring thought disorder with clinical rating scales in schizophrenic and nonschizophrenic patients. Psychiatry Res 1985, 15:313–318.

    Article  PubMed  CAS  Google Scholar 

  14. Solovay MR, Shenton ME, Holzman PS: Comparative studies of thought disorders: I. Mania and schizophrenia. Arch Gen Psychiatry 1987, 44:13–20.

    PubMed  CAS  Google Scholar 

  15. Shenton ME, Solovay MR, Holzman P: Comparative studies of thought disorders: II. Schizoaffective disorder. Arch Gen Psychiatry 1987, 44:21–30.

    PubMed  CAS  Google Scholar 

  16. Abrams R, Taylor MA: Importance of schizophrenic symptoms in the diagnosis of mania. Am J Psychiatry 1981, 138:658–661.

    PubMed  CAS  Google Scholar 

  17. LoweGR: The phenomenology of hallucinations as an aid to differential diagnosis. Br J Psychiatry 1973, 123:621–633.

    PubMed  CAS  Google Scholar 

  18. Winokur G, Clayton PJ, Reich T: Manic Depressive Illness. St. Louis: CV Mosby; 1969.

    Google Scholar 

  19. Carlson GA, Goodwin FK: The stages of mania. A longitudinal analysis of the manic episode. Arch Gen Psychiatry 1973, 28:221–228.

    PubMed  CAS  Google Scholar 

  20. Goodwin DW, Alderson P, Rosenthal R: Clinical significance of hallucinations in psychiatric disorders: a study of 116 hallucinatory patients. Arch Gen Psychiatry 1971, 24:76–80.

    PubMed  CAS  Google Scholar 

  21. Hales RE, Yudofsky SC, Talbott JA: The American Psychiatric Press Textbook of Psychiatry, edn 2. Washington, DC:American Psychiatric Press; 1994.

    Google Scholar 

  22. Fennig S, Bromet EJ, Karant MT, et al.: Mood-congruent versus mood-incongruent psychotic symptoms in first-admission patients with affective disorder. J Affect Disord 1996, 37:23–29.

    Article  PubMed  CAS  Google Scholar 

  23. Tohen M, Tsuang MT, Goodwin DC: Prediction of outcome in mania by mood-congruent or mood-incongruent psychotic features. Am J Psychiatry 1992, 149:1580–1584.

    PubMed  CAS  Google Scholar 

  24. BellL: On a form of disease resembling some advanced stages of mania and fever, but so contradistinguished from any ordinarily observed or described combination of symptoms as to render it probable that it may be overlooked and hitherto unrecorded malady. Am J Insanity 1849, 6:97–127.

    Google Scholar 

  25. BondTC: Recognition of acute delirious mania. Arch Gen Psychiatry 1980, 37:553–554.

    PubMed  CAS  Google Scholar 

  26. Mayer-Gross W, Slater E, Roth M: Clinical Psychiatry, edn 2. London: Cassell & Co.; 1960.

    Google Scholar 

  27. KahlbaumKL: Catatonia. Baltimore: Johns Hopkins University Press; 1973.

    Google Scholar 

  28. Abrams R, Taylor MA: Catatonia: a prospective clinical study. Arch Gen Psychiatry 1976, 33:579–581.

    PubMed  CAS  Google Scholar 

  29. Taylor MA, Abrams R: Catatonia: prevalence and importance in the manic phase of manic-depressive illness. Arch Gen Psychiatry 1977, 34:1223–1225.

    PubMed  CAS  Google Scholar 

  30. Blacker D, Tsuang MT: Contested boundaries of bipolar disorder and the limits of categorical diagnosis in psychiatry. Am J Psychiatry 1992, 149:1473–1483.

    PubMed  CAS  Google Scholar 

  31. Oosthuizen P, Russouw H, Roberts M: Is puerperal psychosis bipolar mood disorder? A phenomenological comparison. Compr Psychiatry 1995, 36:77–81.

    Article  PubMed  CAS  Google Scholar 

  32. Cohen LS, Sichel DA, Robertson LM, et al.: Postpartum prophylaxis for women with bipolar disorder. Am J Psychiatry 1995, 52:1641–1645.

    Google Scholar 

  33. Schopf J, Rust B: Follow-up and family study of postpartum psychoses. Part I: overview. Eur Arch Psychiatry Clin Neurosci 1994, 244:101–111.

    Article  PubMed  CAS  Google Scholar 

  34. Klompenhouwer JL, van HulstAM: Classification of postpartum psychosis: a study of 250 mother and baby admissions in The Netherlands. Acta Psychiatr Scand 1991, 84:255–261.

    PubMed  CAS  Google Scholar 

  35. Pfuhlmann B, Franzek E, Beckmann H, Stober G: Long-term course and outcome of severe postpartum psychiatric disorders. Psychopathology 1999, 32:192–202.

    Article  PubMed  CAS  Google Scholar 

  36. AustinMP: Puerperal affective psychosis: is there a case for lithium prophylaxis? Br J Psychiatry 1992, 161:692–694.

    Article  PubMed  CAS  Google Scholar 

  37. Stewart DE, Klompenhouwer JL, Kendell RE, van HulstAM: Prophylactic lithium in puerperal psychosis. The experience of three centres. Br J Psychiatry 1991, 158:393–397.

    PubMed  CAS  Google Scholar 

  38. LeonhardK: Classification of endogenous psychoses and their differentiated etiology, edn 2. New York: Springer-Verlag Wein; 1999.

    Google Scholar 

  39. Jonsson SA, Jonsson H, Nyman GE: The concept of cycloid psychosis: the discriminatory power of symptoms. Acta Psychiatr Scand 1991, 84:22–25.

    PubMed  CAS  Google Scholar 

  40. Brockington IF, Perris C, Kendell RE, et al.: The course and outcome of cycloid psychosis. Psychol Med 1982, Feb, 12:97–105.

    Article  PubMed  CAS  Google Scholar 

  41. Beckmann H, Fritze J, Lanczik M: Prognostic validity of the cycloid psychoses. A prospective follow-up study. Psychopathology 1990, 23:205–211.

    PubMed  CAS  Google Scholar 

  42. MajM: Cycloid psychotic disorder: validation of the concept by means of a follow-up and a family study. Psychopathology 1990, 23:196–204.

    PubMed  CAS  Google Scholar 

  43. CuttingJ: Relationship between cycloid psychosis and typical affective psychosis. Psychopathology 1990, 23:212–219.

    Article  PubMed  CAS  Google Scholar 

  44. PerrisC: Morbidity suppressive effect of lithium carbonate in cycloid psychosis. Arch Gen Psychiatry 1978, 35:438–431.

    PubMed  CAS  Google Scholar 

  45. MajM: Effectiveness of lithium prophylaxis in schizoaffective psychoses: application of a polydiagnostic approach. Acta Psychiatr Scand 1984, 70:228–234.

    PubMed  CAS  Google Scholar 

  46. Pfuhlmann B, Franzek E, Beckmann H, Stober G: Long-term course and outcome of severe postpartum psychiatric disorders. Psychopathology 1999, 32:192–202.

    Article  PubMed  CAS  Google Scholar 

  47. McNeilTF: A prospective study of postpartum psychoses in a high-risk group. 1. Clinical characteristics of the current postpartum episodes. Acta Psychiatr Scand 1986, 74:205–216.

    PubMed  CAS  Google Scholar 

  48. Jonsson SA, Jonsson H, Nyman AK, Nyman GE: The concept of cycloid psychosis: sensitivity and specificity of syndromes derived by multivariate clustering techniques. Acta Psychiatr Scand 1991, 83:353–362.

    PubMed  CAS  Google Scholar 

  49. Wald D, Lerner J: Lithium in the treatment of periodic catatonia: a case report. Am J Psychiatry 1978, 135:751–752.

    PubMed  CAS  Google Scholar 

  50. PeturssonH: Lithium treatment of a patient with periodic catatonia. Acta Psychiatr Scand 1976, 54:248–253.

    PubMed  CAS  Google Scholar 

  51. Young RC, Biggs JT, Siegler VE, et al.: A rating scale for mania: reliability, validity, and sensitivity. Br J Psychiatry 1978, 133:429–435.

    PubMed  CAS  Google Scholar 

  52. Rennie TAC, Fowler JB: Prognosis in manic-depressive psychoses. Am J Psychiatry 1943, 98:801–814.

    Google Scholar 

  53. Rosen LN, Rosenthal NE, Van DusenPH, et al.: Age at onset and number of psychotic symptoms in bipolar I and schizoaffective disorder. Am J Psychiatry 1989, 146:1149–1154.

    Google Scholar 

  54. McGlashanTH: Adolescent versus adult onset of mania. Am J Psychiatry 1988, 145:221–223.

    PubMed  CAS  Google Scholar 

  55. Ballenger JC, Reus VI, Post RM: The atypical clinical picture of adolescent mania. Am J Psychiatry 1982, 139:602–606.

    PubMed  CAS  Google Scholar 

  56. Carlson GA, Bromet EJ, Sievers S: Phenomenology and outcome of subjects with early- and adult-onset mania. Am J Psychiatry 2000, 157:213–219. An excellent study using an epidemiologic sample.

    Article  PubMed  CAS  Google Scholar 

  57. Coryell W, Norten SG: Mania during adolescence. J Nerv Ment Dis 1980, 168:611–613.

    Article  PubMed  CAS  Google Scholar 

  58. McElroy SL, Strakowski SM, West SA, et al.: Phenomenology of adolescent and adult mania in hospitalized patients with bipolar disorder. Am J Psychiatry 1997, 154:44–49.

    PubMed  CAS  Google Scholar 

  59. Strakowski SM, Shelton RC, Kolbrener ML: The effects of race and comorbidity on clinical diagnosis in patients with psychosis. J Clin Psychiatry 1993, 54:96–102.

    PubMed  CAS  Google Scholar 

  60. Strakowski SM, Flaum M, Amador X, et al.: Racial differences in the diagnosis of psychosis. Schizophr Res 1996, 21:117–124.

    Article  PubMed  CAS  Google Scholar 

  61. Rosenthal NE, Rosenthal LN, Stallone F, et al.: Toward the validation of RDC schizoaffective disorder. Arch Gen Psychiatry 1980, 37:804–810.

    PubMed  CAS  Google Scholar 

  62. Lundquist G: Prognosis and course in manic-depressive psychoses: a follow-up study of 319 first admissions. Acta Psychiatr Neurol 1945, (Suppl 35):1–96.

  63. MacQueen GM, Young LT, Robb JC, et al.: Levels of functioning and well-being in recovered psychotic versus nonpsychotic mania. J Affect Disord 1997, 46:69–72.

    Article  PubMed  CAS  Google Scholar 

  64. Rosenthal NE, Rosenthal LN, Stallone F, et al.: Psychosis as a predictor of response to lithium maintenance treatment in bipolar affective disorder. J Affect Disord 1979, 1:237–245.

    Article  PubMed  CAS  Google Scholar 

  65. Tohen M, Waternaux CM, Tsuang MT: Outcome in mania: a 4-year prospective follow-up of 75 patients utilizing survival analysis. Arch Gen Psychiatry 1990, 47:1106–1111.

    PubMed  CAS  Google Scholar 

  66. Rosen LN, Rosenthal NE, Dunner DL, et al.: Social outcome compared in psychotic and nonpsychotic bipolar I patients. J Nerv Ment Dis 1983, 171:272–275.

    Article  PubMed  CAS  Google Scholar 

  67. WilcoxJA: The predictive value of thought disorder in manic psychosis. Psychopathology 1992, 25:161–165.

    Article  PubMed  CAS  Google Scholar 

  68. Bowden CL, McElroy SL: History of the development of valproate for treatment of bipolar disorder. J Clin Psychiatry. 1995, 56(Suppl 3):3–5.

    PubMed  Google Scholar 

  69. Coryell W, Keller M, Lavori P, Endicott J: Affective syndromes, psychotic features, and prognosis. II. Mania. Arch Gen Psychiatry 1990, 47:658–62.

    PubMed  CAS  Google Scholar 

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Dunayevich, E., Keck, P.E. Prevalence and description of psychotic features in bipolar mania. Curr Psychiatry Rep 2, 286–290 (2000). https://doi.org/10.1007/s11920-000-0069-4

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