Social and symptomatic outcomes of first‐episode bipolar psychoses in an early intervention service

Abstract

Aim: We aimed to establish the relative proportions of all diagnoses in people aged 14-35 years presenting to an early intervention in psychosis service, and to compare demographic variables, symptoms and outcomes between the bipolar psychoses and other psychoses at 3-6 months and 1 year post referral. Methods:Prospective 3-to 6-month diagnostic and symptomatic assessments were carried out. Diagnoses were established using the Diagnostic Interview for Psychoses -Diagnostic Module. Symptoms and outcomes were assessed using standardized instruments at 3-6 months and 1 year. Bipolar diagnoses were grouped together in a bipolar group (n = 16) and compared with all other diagnoses, in a non-bipolar group (n = 62). Parallel analysis was carried out using groups of lifetime elevated, expansive or irritable mood (n = 32) and no lifetime elevated, expansive or irritable mood (n = 46).Results: Bipolar disorders account for 20.5% of all new presentations to our service. Differences in outcomes over the range of psychotic diagnoses relate to early presence of negative symptoms. Psychoses with bipolar diagnoses or lifetime elevated, expansive or irritable mood showed lower rates of negative symptoms than other psychoses and had a higher quality of life and higher function at 3-6 months and 1 year. Conclusions:Planning for future early intervention services should take the high rate of affective psychoses and their need for diagnosisspecific, evidence-based treatments into account. Lifetime elevated, expansive or irritable mood may predict improved outcomes in early psychoses, possibly mediated by lower levels of negative symptoms.

Cognitive behaviour therapy for improving social recovery in psychosis: a report from the ISREP MRC Trial Platform study (Improving Social Recovery in Early Psychosis)

“…As cases in the affective and non-affective psychosis groups were well matched on clinical and social factors, the differences observed between these two groups are unlikely to be due to variables such as duration of either illness or unemployment. The findings may be more consistent with our recent observations, and those of others, that bipolar disorder cases respond rapidly and with good social recovery outcomes to early intervention services compared with non-affective psychosis (Macmillan et al 2007).…”

“…Our aim was also to clarify and define selection criteria and we therefore included people with both affective and non-affective psychosis. Previous studies have shown that people with affective psychosis tend to make better recoveries after the first episode (Macmillan et al 2007) and have better social outcomes generally than people with non-affective psychosis (Werry et al 1991; Cannon et al 1997; Jarbin et al 2003). We therefore aimed to explore the differential effect of the intervention on affective and non-affective psychosis.…”

Quality prescribing in early psychosis: key pharmacotherapy principles

“…Affective psychoses represent a substantial proportion (~31%) of EP service users. 23 A restricted positive symptom focus will invariably result in inadequate treatment of manic episodes. Depression is also often overlooked in people presenting with psychosis.…”