Psychosocial Functioning, Familiality, and Psychiatric Comorbidity in Bipolar Youth With and Without Psychotic Features

Abstract

Objective Few studies have examined the correlates of psychosis in children and adolescents with Bipolar Disorder (BPD). We examined psychiatric comorbidity, familiality, and psychosocial functioning in multiple domains in BPD children and adolescents with and without psychotic features. Methods As part of two ongoing family-based studies of children and adolescents with BPD, we compared youth and their families with psychotic symptoms (BPD+P) and without psychotic symptoms (BPD−P). All youth and family members were assessed by structured psychiatric interviews in a blinded manner. One study was conducted from January 2000 through December 2004, and the other study was conducted from February 1997 through September 2006. Results Of the 226 youth with BPD, 33% manifested psychotic symptoms, as defined by the presence of hallucinations or delusions. We found that BPD+P had a greater number of BPD episodes, more psychiatric hospitalizations, and significantly higher rates of psychiatric comorbidity compared to BPD−P. Additionally, a higher percentage of BPD+P had a family history of psychosis. There was a lower processing speed and lower arithmetic scaled score in BPD+P youth, but no other meaningful differences in cognitive variables were identified between the two BPD groups. Psychosis in BPD was also associated with decreased family cohesion and poorer overall global functioning. Conclusions In children and adolescents with BPD, those who manifest psychotic features have higher rates of comorbid psychopathology, family history of psychosis, and poorer overall functioning in multiple domains than BPD children without psychosis. Future studies should examine neuroimaging correlates, medication response, and longitudinal course of BPD children and adolescents who manifest psychosis as part of their clinical picture.

Social Functioning and Age Across Affective and Nonaffective Psychoses

“…At least partial disability is reported in approximately 80% of patients with PBD; as many as 65% of patients reported being unemployed even after clinical recovery, and patients experience significant disability in daily living and social functioning (Goldstein et al, 2009; Hua et al, 2011; Rosen et al, 1983; Sanchez-Moreno et al, 2009). Similar to non-affective psychosis, social dysfunction in BD is present during periods of both symptom exacerbation and euthymia (e.g., Sanchez-Moreno et al, 2009), with up to 65% of individuals failing to obtain pre-morbid levels of social functioning after disease onset (Strakowski et al, 1998; Tohen et al, 2000).…”

Cognitive and psychosocial functioning in bipolar disorder with and without psychosis during early remission from an acute mood episode: A comparative longitudinal study

“…In addition to cognitive impairment, psychosis is associated with lower psychosocial functioning in patients with BD 9,10,11,12 . Studies suggest that psychosis is related to poorer adaptive functioning across the life span, including reduced family cohesion in youth 10,11 limited employment during adulthood, and premature decline in activities of daily living (ADL) among the elderly 9 .…”

“…Studies suggest that psychosis is related to poorer adaptive functioning across the life span, including reduced family cohesion in youth 10,11 limited employment during adulthood, and premature decline in activities of daily living (ADL) among the elderly 9 . Psychosis in BD is also associated with increased morbidity 13 , and reduced functional recovery 12 .…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

“…Psychotic symptoms have been reported in about one-third of youth with BD, and confer a significantly greater likelihood of lifetime GAD, agoraphobia, social phobia, and obsessive compulsive disorder (OCD) (236). Medical comorbidities including obesity, type 2 diabetes mellitus, other endocrine disorders, migraine headaches, central nervous system disorders ⁄ epilepsy, organic brain disorders ⁄ mental retardation, cardiovascular disorders, and asthma in a large cohort study were significantly more prevalent among children and adolescents with BD (n = 1841) compared to a control group (n = 4500) (237).…”