Differentiating schizoaffective and bipolar I disorder in first-episode psychotic mania
Schizophrenia Research, 08/09/2012
Schottle D et al. – The findings suggest that it is difficult to distinguish bipolar–I–disorder (BD) with psychotic symptoms and schizoaffective disorder (SAD) in patients presenting with first–episode psychotic mania (FEPM). Longer duration of untreated psychosis (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.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.
- 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 η2=0.12) and psychosocial functioning (GAF; partial η2=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.