Lifetime and point prevalence of psychotic symptoms in adults with bipolar disorders: a systematic review and meta-analysis

Abstract

Psychotic symptoms, that we defined as delusions or hallucinations, are common in bipolar disorders (BD). This systematic review and meta-analysis aims to synthesise the literature on both lifetime and point prevalence rates of psychotic symptoms across different BD subtypes, including both BD type I (BDI) and BD type II (BDII). We performed a systematic search of Medline, PsycINFO, Embase and Cochrane Library until 5 August 2021. Fifty-four studies (N = 23 461) of adults with BD met the predefined inclusion criteria for evaluating lifetime prevalence, and 24 studies (N = 6480) for evaluating point prevalence. Quality assessment and assessment of publication bias were performed. Prevalence rates were calculated using random effects meta-analysis, here expressed as percentages with a 95% confidence interval (CI). In studies of at least moderate quality, the pooled lifetime prevalence of psychotic symptoms in BDI was 63% (95% CI 57.5–68) and 22% (95% CI 14–33) in BDII. For BDI inpatients, the pooled lifetime prevalence was 71% (95% CI 61–79). There were no studies of community samples or inpatient BDII. The pooled point prevalence of psychotic symptoms in BDI was 54% (95 CI 41–67). The point prevalence was 57% (95% CI 47–66) in manic episodes and 13% (95% CI 7–23.5) in depressive episodes. There were not enough studies in BDII, BDI depression, mixed episodes and outpatient BDI. The pooled prevalence of psychotic symptoms in BDI may be higher than previously reported. More studies are needed for depressive and mixed episodes and community samples. Prospero registration number: CRD 42017052706.

Dimensions of psychopathology associated with psychotic-like experiences: Findings from the network analysis in a nonclinical sample

“…Also, psychotic symptoms are highly prevalent in patients with bipolar disorder and those with borderline personality disorder. A recent meta-analysis estimated the pooled lifetime prevalence of psychotic symptoms at 63% in type I bipolar disorder and 22% in type II bipolar disorder [42]. It has also been shown that 20–50% of individuals with borderline personality disorder report psychotic symptoms [43].…”

Reprioritising global mental health: psychoses in sub-Saharan Africa

“…The term “psychosis” is a phenomenological concept operationalised by various diagnostic classification systems to describe an individual’s experience of symptoms (e.g., delusions, hallucinations, disorganised thinking) that characterise a number of “psychotic disorders” [ 21 ], but may also occur in individuals with other mental and neurological disorders (e.g., depressive and anxiety disorders, bipolar type I and II [ 19 , 22 , 23 ]), or even in the absence of any diagnosable mental disorder (e.g., as a result of sleep deprivation, certain physical health conditions like HIV/AIDS, malaria and typhoid, some medications like chloroquine and corticosteroids, alcohol and illicit drug use, etc. [ 24 – 26 ]).…”

Subfield‐specific longitudinal changes of hippocampal volumes in patients with early‐stage bipolar disorder

“…Moreover, BPD patients are a heterogeneous population, with over 60% of patients developing psychotic symptoms during their lifetime. 18 Robust evidence from epidemiological and genetic studies indicates that psychosis spectrum disorders, including schizophrenia (SZ), schizoaffective disorder (SA), and BPD with psychosis, have substantial overlap in symptomatology and genetic liability. 19 Numerous genome-wide association studies indicate overlap in susceptibility across BPD, SA, SZ, and related phenotypes.…”