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Axis I comorbidity in bipolar disorder with psychotic features

Published online by Cambridge University Press:  03 January 2018

Stefano Pini*
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
Liliana Dell'Osso
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
Concettina Mastrocinque
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
Giovanni Marcacci
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
Alessandra Papasogli
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
Serena Vignoli
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
Stefano Pallanti
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
Giovanni B. Cassano
Affiliation:
Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
*
Dr Stefano Pini. DPNFB–Department of Psychiatry, University of Pisa, via Roma 67, 56100 Pisa, Italy. Tel: +39 50 835–419; Fax: +39 50 21–581

Abstract

Background

Axis I comorbidities are prevalent among patients with severe bipolar disorder but the clinical and psychopathological implications are not clear.

Aims

To investigate characteristics of four groups of patients categorised as follows: substance abuse only (group I), substance abuse associated with other Axis I disorders (group 2), non-substance-abuse Axis I comorbidity (group 3), no psychiatric comorbidity (group 4)

Method

Consecutive patients with bipolar disorder with psychotic features (n=125) were assessed using the Structured Clinical Interview for DSM–III–R – patient version, and several psychopathological scales.

Results

By comparison with group 4, group I had a higher risk of having mood-incongruent delusions, group 2 had an earlier age at onset of mood disorder, a more frequent onset with a mixed state and a higher risk of suicide, and group 3 had more severe anxiety and a better awareness of illness.

Conclusions

Substance abuse, non-substance-abuse Axis I comorbidity and their reciprocal association are associated with different characteristics of bipolar disorder.

Type
Papers
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

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Footnotes

Declaration of interest

This study was supported by funds from the Department of Psychiatry, University of Pisa.

References

Amador, X. F., Strauss, D. H., Yale, S. A., et at (1993) Assessment of insight in psychosis. American Journal of Psychiatry, 150, 873879.Google ScholarPubMed
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.Google Scholar
Andreasen, N. C. (1983) The Scale for the Assessment of Negative Symptoms. Iowa City, IA: University of lowa.Google Scholar
Black, D. W., Winokur, G., Bell, S., et al (1988) Complicated mania: comorbidity and immediate outcome in the treatment of mania. Archives of General Psychiatry, 45, 232236.CrossRefGoogle ScholarPubMed
Brady, K. T. & Sonna, S. C. (1995) The relationship between substance abuse and bipolar disorder. Journal of Clinical Psychiatry, 56 (suppl. 3), 1924.Google ScholarPubMed
Brook, J. S., Cohen, P. & Brook, D. W. (1998) Longitudinal study of co-occurring psychiatric disorders and substance use. Journal of the American Academy of Child and Adolescence Psychiatry, 37, 322330.CrossRefGoogle ScholarPubMed
Cassano, G. B., Pini, S., Saettoni, M., et al (1998) Occurrence and clinical correlates of psychiatric comorbidrty in patients with psychotic disorders. Journal of Clinical Psychiatry, 59, 6068.CrossRefGoogle ScholarPubMed
Cassano, G. B., Pini, S., Saettoni, M., et al (1999) Multiple anxiety disorders comorbidity in patients with mood spectrum disorders with psychotic features. American Journal of Psychiatry, 156, 474476.CrossRefGoogle ScholarPubMed
Gehan, E. A. (1997) The scientific basis of clinical trials. Clinical Cancer Research, 3, 25872590.Google ScholarPubMed
Kasch, K. L. & Klein, D. N. (1996) The relationship between age at onset and comorbidity in psychiatric disorders. Journal of Nervous and Mental Disease, 184, 703707.CrossRefGoogle ScholarPubMed
Keck, P. E., McElroy, S. L., Strakowski, S. M., et al (1995) Outcome and comorbidity in first- compared with multiple episode mania. Journal of Nervous and Mental Disease, 183, 320324.CrossRefGoogle ScholarPubMed
Kassier, R. C., Rubinow, D. R., Holmes, C., et al (1997) The epidemiology of DSM – III–R bipolar I disorder in a general population survey. Psychological Medicine, 27, 10791089.Google Scholar
McElroy, S. L., Strakowski, S. M., West, S. A., et al (1997) Phenomenology of adolescent and adult mania in hospitalized patients with bipolar disorder. American Journal of Psychiatry, 154, 4449.Google ScholarPubMed
Overall, J. E. & Gorham, D. R. (1962) The Brief Psychiatric Rating Scale. Psychological Reports, 10, 799812.CrossRefGoogle Scholar
Schatzberf, A. F. (1998) Bipolar disorder: recent issues in diagnosis and classification, Journal of Clinical Psychiatry, 59 (suppl. 6), 510.Google Scholar
Scott, H., Johnson, S., Menezes, P., et al (1998) Substance misuse and risk of aggression and offending among the severely mentally ill. British Journal of Psychiatry, 172, 345350.CrossRefGoogle ScholarPubMed
Sonne, S. C., Brady, K. T. & Morton, W. A. (1994) Substance abuse and bipolar affective disorder. Journal of Nervous and Mental Disease, 182, 349352.CrossRefGoogle ScholarPubMed
Spitzer, R. L., Williams, J. B. W., Gibbon, M., et al (1987) Structured Clinical Interview for DSM–III–R – Patient Version (SC1D–P). New York: New York State Psychiatric Institute.Google Scholar
Strakowski, S. M., Tönen, M. Stoll, A. L., et al (1992) Comorbidity in mania at first hospitalisation. American Journal of Psychiatry, 149, 554556.Google Scholar
Strakowski, S. M., McElroy, S. L., Keck, P. E. Jr., et al (1996) The effects of antecedent substance abuse on the development of first-episode psychotic mania. Journal of Psychiatric Research, 30, 5968.CrossRefGoogle ScholarPubMed
Strakowski, S. M., Keck, P. Jr., McBroy, S., et al. (1998) Twelve-month outcome after a first hospitalisation for affective psychosis. Archives of General Psychiatry, 55, 4955.CrossRefGoogle ScholarPubMed
Winokur, G., Black, D. W. & Nasrallah, A. (1988) Depression secondary to other psychiatric disorders and medical illnesses. American Journal of Psychiatry, 145, 233237.Google ScholarPubMed
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