Is impaired outcome following a first manic episode due to mood-incongruent psychosis?

Background: Mood-incongruent psychosis during the course of bipolar disorde r has been associated with poor outcome. However, it remains unknown whethe r this is secondary to persistent affective or psychotic symptoms or both. Method: Fifty patients with bipolar disorder between the ages of 16 and 45 years were recruited during their first psychiatric hospitalization for man ia. These patients were evaluated using structured and semi-structured clin ical instruments then followed longitudinally. Outcomes during the first ei ght months of follow-up were compared between patients with mood-incongruen t psychosis and those without (i.e., patients with mood-congruent psychosis or no psychosis) during the index manic episode. Specifically, ratings of the percent of weeks during follow-up with psychosis and affective syndrome s and symptoms, as well as ratings of global outcome (GAF), were compared. Results: patients with mood-incongruent psychosis at the index hospitalizat ion exhibited significantly more weeks during follow-up with both mood-inco ngruent and mood-congruent psychotic symptoms th;un patients without mood-i ncongruent psychosis. Mood-incongruent psychosis was also associated with p oorer overall functioning during the outcome interval. The groups did not d iffer in the percent of weeks with affective syndromes or symptoms. Treatme nt during follow-up did not differ between groups and was not associated wi th outcome variables in general. Conclusion: Mood-incongruent psychosis tha t occurs during the first manic episode appears to predict an increased lik elihood of persistent psychotic symptoms during the subsequent eight months . This persistence of psychosis is associated with a worse overall course o f illness as compared to patients without mood-incongruent psychosis. Limit ations: These results apply to a relatively short outcome period and are fr om a single, center. (C) 2000 Elsevier Science B.V. All rights reserved.