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The characteristics of psychotic features in bipolar disorder

Published online by Cambridge University Press:  10 October 2018

Annet H. van Bergen ,
Sanne Verkooijen ,
Annabel Vreeker ,
Lucija Abramovic ,
Manon H. Hillegers ,
Annet T. Spijker ,
Erik Hoencamp ,
Eline J. Regeer ,
Stefan E. Knapen  and
Rixt F. Riemersma-van der Lek
...Show all authors
Annet H. van Bergen*
Affiliation:
Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands Department of Psychiatry, Rode Kruis Ziekenhuis, Beverwijk, The Netherlands
Sanne Verkooijen
Affiliation:
Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands
Annabel Vreeker
Affiliation:
Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands
Lucija Abramovic
Affiliation:
Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands
Manon H. Hillegers
Affiliation:
Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
Annet T. Spijker
Affiliation:
Department of Mood Disorders, PsyQ, The Hague and Rotterdam, The Netherlands
Erik Hoencamp
Affiliation:
Parnassie Group, The Hague, The Netherlands Insitute of Psychology Leiden University, Leiden, The Netherlands
Eline J. Regeer
Affiliation:
Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
Stefan E. Knapen
Affiliation:
Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Rixt F. Riemersma-van der Lek
Affiliation:
Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Robert Schoevers
Affiliation:
Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Anja W. Stevens
Affiliation:
Dimence Center for Bipolar Disorders, Almelo, The Netherlands
Peter F.J Schulte
Affiliation:
Mental Health Service, Noord Holland Noord, Alkmaar, The Netherlands
Ronald Vonk
Affiliation:
Reinier van Arkel, ’s-Hertogenbosch, The Netherlands
Rocco Hoekstra
Affiliation:
Antes, Delta Center for Mental Health Care, Rotterdam, The Netherlands
Nico J. van Beveren
Affiliation:
Antes, Delta Center for Mental Health Care, Rotterdam, The Netherlands
Ralph W. Kupka
Affiliation:
Altrecht Institute for Mental Health Care, Utrecht, The Netherlands Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
Iris E.C. Sommer
Affiliation:
Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Roel A. Ophoff
Affiliation:
Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands Semel Institute For Neuroscience and Human Behavior, University of California, Los Angeles, USA
René S. Kahn
Affiliation:
Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands Department of Psychiatry, Mount Sinai School of Medicine, New York, USA
Marco P.M. Boks
Affiliation:
Department of Psychiatry, University Medical Center Utrecht, Brain Center Rudolf Magnus, Utrecht, The Netherlands
*
Author for correspondence: Annet H. van Bergen, E-mail: annetvb@hotmail.com
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Abstract

Background

In 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.

Methods

In 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.

Results

A 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).

Conclusions

In 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.

Keywords

Childhood traumacognitive functioningdelusionsformal thought disorderhallucinationsmood incongruent symptomspsychosisSchneiderian symptoms
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 12 , September 2019 , pp. 2036 - 2048
Copyright
Copyright © Cambridge University Press 2018 

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