Differentiating schizoaffective and bipolar I disorder in first-episode psychotic mania.

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State: Public
Version: author
Serval ID
serval:BIB_E29C3850C186
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Differentiating schizoaffective and bipolar I disorder in first-episode psychotic mania.
Journal
Schizophrenia Research
Author(s)
Schöttle D., Schimmelmann B.G., Conus P., Cotton S.M., Michel C., McGorry P.D., Karow A., Naber D., Lambert M.
ISSN
1573-2509 (Electronic)
Publication state
Published
Issued date
2012
Peer-reviewed
Oui
Volume
140
Number
1-3
Pages
31-36
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish
Abstract
OBJECTIVE: This study aims to differentiate schizoaffective disorder (SAD) and bipolar-I-disorder (BD) in first-episode psychotic mania (FEPM).
METHODS: All 134 patients from an epidemiological first-episode psychosis cohort (N=786) with FEPM and an 18-month follow-up final diagnosis of SAD (n=36) or BD (n=98) were assessed with respect to pre-treatment, baseline and outcome differences. Second, patients with baseline BD who shifted (shifted BD) or did not shift to SAD (stable BD) over the follow-up period were compared regarding pre-treatment and baseline differences.
RESULTS: SAD patients displayed a significantly longer duration of untreated psychosis (DUP; effect size r=0.35), a higher illness-severity at baseline (r=0.20) and more traumatic events (Cramer-V=0.19). SAD patients displayed a significantly higher non-adherence rate (Cramer-V=0.19); controlling for time in treatment and respective baseline scores, SAD patients had significantly worse illness severity (CGI-S; partial η(2)=0.12) and psychosocial functioning (GAF; partial η(2)=0.07) at 18-months, while BD patients were more likely to achieve remission of positive symptoms (OR=4.9, 95% CI=1.8-13.3; p=0.002) and to be employed/occupied (OR=7.7, 95% CI=2.4-24.4, p=0.001). The main discriminator of stable and shifted BD was a longer DUP in patients shifting from BD to SAD.
CONCLUSIONS: It is difficult to distinguish BD with psychotic symptoms and SAD in patients presenting with FEPM. Longer DUP is related to SAD and to a shift from BD to SAD. Compared to BD, SAD had worse outcomes and higher rates of non-adherence with medication. Despite these differences, both diagnostic groups need careful dimensional assessment and monitoring of symptoms and functioning in order to choose the right treatment.
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Create date
24/09/2012 13:36
Last modification date
20/08/2019 16:06
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