Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-10T10:56:46.727Z Has data issue: false hasContentIssue false
  • English
  • Français

Affective dimensions as a diagnostic tool for bipolar disorder in first psychotic episodes

Published online by Cambridge University Press:  15 April 2020

M. Arrasate ,
I. González-Ortega ,
S. Alberich ,
M. Gutierrez ,
M. Martínez-Cengotitabengoa ,
F. Mosquera ,
N. Cruz ,
M.A. González-Torres ,
C. Henry  and
A. González-Pinto
M. Arrasate
Affiliation:
Department of Psychiatry, Basurto Hospital, EHU/UPV, Bilbao, Spain
I. González-Ortega
Affiliation:
CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain
S. Alberich
Affiliation:
CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain
M. Gutierrez
Affiliation:
CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain
M. Martínez-Cengotitabengoa
Affiliation:
CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain
F. Mosquera
Affiliation:
CIBERSAM, Araba Mental Health, Vitoria-Gasteiz, Spain
N. Cruz
Affiliation:
CIBERSAM, EMBREC, Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, Barcelona, Spain
M.A. González-Torres
Affiliation:
Department of Psychiatry, Basurto Hospital, EHU/UPV, Bilbao, Spain
C. Henry
Affiliation:
EMBREC, Department of Psychiatry, Paris, France
A. González-Pinto*
Affiliation:
CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain
*
*Corresponding author. CIBERSAM, Araba University Hospital - Santiago, EHU/UPV, Olaguibel 29, Vitoria-Gasteiz, Spain. Tel.: +34 945 007770; fax: +34 945 007764. E-mail address: anamaria.gonzalez-pintoarrillaga@osakidetza.net (A. González-Pinto).
Get access

Abstract

Objective

To examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years’ follow-up.

Method

Affective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or “other psychosis”. The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed.

Results

Manic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. “other psychosis”. Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio = 1.383; 95% confidence interval, 1.205–1.587; P = 0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis.

Conclusion

The activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.

Keywords

AffectiveBipolarDimensionFirst psychosisActivation
Type
Original article
Information
European Psychiatry , Volume 29 , Issue 7 , September 2014 , pp. 424 - 430
Copyright
Copyright © 2013 Elsevier Masson SAS

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akiskal, H.S., Benazzi, F., Perugi, G., Rihmer, Z.Agitated unipolar depression re-conceptualized as a depressive mixed state: implications for the antidepressant-suicide controversy. J Affect Disord 2005;85:245–258.CrossRefGoogle ScholarPubMed
Allardyce, J., McCreadie, R.G., Morrison, G., Van Os, J.Do symptom dimensions or categorical diagnoses best discriminate between known risk factors for psychosis?. Soc Psychiatry Psychiatr Epidemiol 2007;42:429–437.CrossRefGoogle ScholarPubMed
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Revised 3rd (DSM-III-R). Washington, DC: American Psychiatric Association; 1987.Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition (DSM-IV). Washington, DC: American Psychiatric Association; 1994.Google Scholar
Angst, J., Gamma, A., Benazzi, F., Ajdacic, V., Rössler, W.Does psychomotor agitation in major depressive episodes indicate bipolarity? Evidence from the Zurich Study. Eur Arch Psychiatry Clin Neurosci 2009;259:55–63.CrossRefGoogle ScholarPubMed
Dikeos, D.G., Wickham, H., McDonald, C., Walshe, M., Sigmundsson, T., Bramon, E.et al.Distribution of symptom dimensions across Kraepelinian divisions. Br J Psychiatry 2006;189:346–353.CrossRefGoogle ScholarPubMed
Eaton, W.W., Thara, R., Federman, E., Tien, A.Remission and relapse in schizophrenia: the Madras longitudinal study. J Nerv Ment Dis 1998;186:357–363.CrossRefGoogle ScholarPubMed
Goldberg, J.F., Harrow, M., Whiteside, J.E.Risk for bipolar illness in patients initially hospitalized for unipolar depression. Am J Psychiatry 2001;158:1265–1270.CrossRefGoogle ScholarPubMed
González-Pinto, A., Alberich, S., Barbeito, S., Gutierrez, M., Vega, P., Ibáñez, B.et al.Cannabis and first-episode psychosis: different long-term outcomes depending on continued or discontinued use. Schizophr Bull 2011;37:631–639.CrossRefGoogle ScholarPubMed
González-Pinto, A., Ballesteros, J., Aldama, A., Pérez de Heredia, J.L., Gutierrez, M., Mosquera, F.et al.Principal components of mania. J Affect Disord 2003;76:95–102.CrossRefGoogle ScholarPubMed
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56–62.CrossRefGoogle ScholarPubMed
Hegerl, U., Bottner, A.C., Holtschmidt-Täschner, B., Born, C., Seemüller, F., Scheunemann, W.et al.Onset of depressive episodes is faster in patients with bipolar versus unipolar depressive disorder: evidence from a retrospective comparative study. J Clin Psychiatry 2008;69:1075–1080.CrossRefGoogle ScholarPubMed
Henry, C., M’Bailara, K., Lépine, J.P., Lajnef, M., Leboyer, M.Defining bipolar mood states with quantitative measurement of inhibition/activation and emotional reactivity. J Affect Disord 2010;127:300–304.CrossRefGoogle ScholarPubMed
Kay, S.R., Opler, L., Fiszbein, A.The Positive and Negative Syndrome Scale (PANSS). Rating manual. Toronto: Multi-Health Systems; 1986.Google Scholar
Keshavan, M.S., Schooler, N.R.First-episode studies in schizophrenia: criteria and characterization. Schizophr Bull 1992;18:491–513.CrossRefGoogle ScholarPubMed
Kitamura, T., Okazaki, Y., Fujinawa, A., Yoshino, M., Kasahara, Y.Symptoms of psychoses; a factor-analytic study. Br J Psychiatry 1995;166:236–240.CrossRefGoogle ScholarPubMed
McGorry, P.D., Bell, R.C., Dudgeon, P.L., Jackson, H.J.The dimensional structure of first episode psychosis: an exploratory factor analysis. Psychol Med 1998;28:935–947.CrossRefGoogle ScholarPubMed
McIntosh, A.M., Forrester, A., Lawrie, S.M., Byrne, M., Harper, A., Kestelman, J.N.et al.A factor model of the functional psychoses and the relationship of factors to clinical variables and brain morphology. Psychol Med 2001;31:159–171.CrossRefGoogle ScholarPubMed
Mitchell, P.B., Goodwin, G.M., Johnson, G.F., Hirschfeld, R.M.Diagnostic guidelines for bipolar depression: a probabilistic approach. Bipolar Disord 2008;10:144–152.CrossRefGoogle ScholarPubMed
Murray, V., McKee, I., Millar, P.M., Young, D., Muir, W.J., Pelosi, A.J.et al.Dimensions and classes of psychosis in a population cohort: a four-class, four-dimension model of schizophrenia and affective psychoses. Psychol Med 2005;35:499–510.CrossRefGoogle Scholar
Perlis, R.H., Brown, E.B., Baker, R.W., Nierenberg, A.A.Clinical features of bipolar depression versus major depressive disorder in large multicenter trials. Am J Psychiatry 2006;163:225–231.CrossRefGoogle ScholarPubMed
Phillips, L.Case history data and prognosis in schizophrenia. J Nerv Ment Dis 1953;117:515–525.CrossRefGoogle Scholar
Reininghaus, U., Priebe, S., Bentall, R.P.Testing the psychopathology of psychosis: evidence for a general psychosis dimension. Schizophr Bull 2013;39:884–895.CrossRefGoogle ScholarPubMed
Rosenman, S., Korten, A., Medway, J., Evans, M.Characterising psychosis in the Australian National Survey of Mental Health and Wellbeing Study on low-prevalence (psychotic) disorders. Aust N Z J Psychiatry 2000;34:792–800.CrossRefGoogle Scholar
Salvatore, P., Khalsa, H.M.K., Hennen, J., Tohen, M., Yurgelun-Todd, D., Casolari, F.et al.Psychopathology factors in first-episode affective and non-affective psychotic disorders. J Psychiatric Res 2007;41:724–736.CrossRefGoogle ScholarPubMed
Sheitman, B.B., Lee, H., Strauss, R., Lieberman, J.A.The evaluation and treatment of first-episode psychosis. Schizophr Bull 1997;23:653–661.CrossRefGoogle ScholarPubMed
Sipos, A., Harrison, G., Gunnell, D., Amin, S., Singh, S.P.Patterns and predictors of hospitalization in first-episode psychosis. Br J Psychiatry 2001;178:518–523.CrossRefGoogle ScholarPubMed
Spitzer, R.L., Williams, J.B.W., Gibbon, M., First, M.Structured Clinical Interview for DSM-IV (SCID I, Version 2.0). Indiana: Lilly Research Laboratories; 1996.Google Scholar
Strauss, J.R., Carpenter, W.T.The prediction of outcome in schizophrenia. I. Characteristics of outcome. Arch Gen Psychiatry 1972;27:739–746.CrossRefGoogle Scholar
Tohen, M., Khalsa, H.M., Salvatore, P., Vieta, E., Ravichandran, C., Baldessarini, R.J.Two-year outcomes in first-episode psychotic depression: the McLean-Harvard First-Episode Project. J Affect Disord 2012;136:1–8.CrossRefGoogle ScholarPubMed
Tsuang, M.T., Dempsey, G.M., Rauscher, F.A study of atypical schizophrenia: comparison with schizophrenia and affective disorder by sex, age of admission, precipitant, outcome, and family history. Arch Gen Psychiatry 1976;33:11157–11160.CrossRefGoogle ScholarPubMed
Van Os, J., Kapur, S.Schizophrenia. Lancet 2009;374:635–645.CrossRefGoogle ScholarPubMed
Van Os, J., Fahy, T.A., Jones, P., Harvey, I., Sham, P., Lewis, S.et al.Psychopathological syndromes in the functional psychoses: associations with course and outcome. Psychol Med 1996;26:161–176.CrossRefGoogle ScholarPubMed
Van Os, J., Gilvarry, C., Bale, R., Van Horne, E., Tattan, T., White, I.et al.A comparison of the utility of dimensional and categorical representations of psychosis. Psychol Med 1999;29:595–606.CrossRefGoogle Scholar
Van Os, J., Gilvarry, C., Bale, R., Van Horne, E., Tattan, T., White, I.et al.Diagnostic value of the DSM and ICD categories of psychosis: an evidence-based approach. Soc Psychiatry Psychiatr Epidemiol 2000;35:305–311.CrossRefGoogle Scholar
Ventura, J., Nuechterlein, K.H., Subotnik, K.L., Gutkind, D., Gilbert, E.A.Symptom dimensions in recent-onset schizophrenia and mania: a principal components analysis of the 24-item Brief Psychiatric Rating Scale. Psychiatry Res 2000;97:129–135.CrossRefGoogle ScholarPubMed
Young, R.C., Biggs, T., Ziegler, E., Meyer, D.A.A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;13:429–435.CrossRefGoogle Scholar
Submit a response

Comments

No Comments have been published for this article.