Axis I comorbidity in bipolar disorder with psychotic features

Background Axis 1 comorbidities are prevalent among patients with severe bi polar 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 1 disorders (group 2), non-substance-abuse Axis 1 comorbidity ( group 3), no psychiatric comorbidity (group 4). Method Consecutive patients with bi polar 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 1 had a higher risk of having moo d-incongruent delusions, group 2 had an earlier age at onset of mood disord er, 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,nonsubstance-abuse Axis ` comorbidity and their reciprocal association are associated with different characteristics of bi polar disorder. Declaration of interest This study was supported by funds from the Departme nt of Psychiatry, University of Pisa.