Psychotic features, particularly mood incongruence, as a hallmark of severity of bipolar I disorder

Julien Elowe; Julie Vallat; Enrique Castelao; Marie-Pierre F Strippoli; Mehdi Gholam; Setareh Ranjbar; Jennifer Glaus; Kathleen Merikangas; Benjamin Lavigne; Pierre Marquet; Martin Preisig; Caroline L Vandeleur

doi:10.1186/s40345-022-00280-6

Psychotic features, particularly mood incongruence, as a hallmark of severity of bipolar I disorder

Int J Bipolar Disord. 2022 Dec 18;10(1):31. doi: 10.1186/s40345-022-00280-6.

Authors

Affiliations

¹ Department of Psychiatry, Lausanne University Hospital and University of Lausanne, West Sector, Chemin Oscar Forel 3, Prangins, 1197, Canton of Vaud, Switzerland. julien.elowe@chuv.ch.
² Department of Psychiatry, Lausanne University Hospital and University of Lausanne, North Sector, Yverdon, Canton of Vaud, Switzerland. julien.elowe@chuv.ch.
³ Department of Psychiatry, Psychiatric Epidemiology and Psychopathology Research Center, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland.
⁴ Child and Adolescent Psychiatry Clinics, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
⁵ Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA.
⁶ Department of Psychiatry, Lausanne University Hospital and University of Lausanne, West Sector, Chemin Oscar Forel 3, Prangins, 1197, Canton of Vaud, Switzerland.
⁷ Department of Psychiatry, Center for Psychiatric Neuroscience, Lausanne University Hospital and University of Lausanne, Prilly, Switzerland.
⁸ International Research Unit in Neurodevelopment and Child Psychiatry, Laval University, Quebec, Canada.

Abstract

Background: The occurrence of psychotic features within mood episodes in patients with bipolar I disorder (BD I) has been associated in some studies with a more severe clinical and socio-professional profile. In contrast, other studies establishing the associations of psychotic features in BD I, and in particular of mood-congruent (MC) and mood-incongruent (MI) features, with clinical characteristics have yielded contradictory results. However, many pre-existing studies have been affected by serious methodological limitations. Using a sample of thoroughly assessed patients with BD I our aims were to: (1) establish the proportion of those with MI and MC features, and (2) compare BD I patients with and without psychotic features as well as those with MI to those with MC features on a wide array of socio-demographic and clinical characteristics including course, psychiatric comorbidity and treatment.

Methods: A sample of 162 treated patients with BD I (60.5% female, mean age = 41.4 (s.d: 10.2) years) was recruited within a large family study of mood disorders. Clinical, course and treatment characteristics relied on information elicited through direct diagnostic interviews, family history reports and medical records.

Results: (1) A total of 96 patients (59.3%) had experienced psychotic features over their lifetime. Among them, 44.8% revealed MI features at least once in their lives. (2) Patients with psychotic features were much less likely to be professionally active, revealed alcohol abuse more frequently and used health care, particularly inpatient treatment, more frequently than those without psychotic features. Within patients with psychotic symptoms, those with MI features showed more clinical severity in terms of a higher likelihood of reporting hallucinations, suicidal attempts and comorbid cannabis dependence.

Conclusion: Our data provide additional support for both the distinction between BD-I with and without psychotic features as well as the distinction between MI and MC psychotic features. The more severe course of patients with psychotic features, and particularly those with MI psychotic features, highlights the need for thorough psychopathological evaluations to assess the presence of these symptoms to install appropriate treatment.

Keywords: Bipolar I disorder; Clinical characteristics; Mood congruence; Mood incongruence; Psychiatric comorbidity; Psychotic features; Suicide attempts; Treatment.