Aims and objectives: Though mania is considered a mood disorder and presents with elevated/irritable mood, increased goal-directed activity, pressure of speech, and flight of ideas, they can also manifest with psychotic symptoms including Schneiderian first-rank symptoms. The present study was undertaken to compare and study any differences between psychotic mania and nonpsychotic mania groups.
Materials and methods: We compared the sociodemographic and clinical variables between 30 psychotic and 30 nonpsychotic mania patients, i.e., a total of 60 patients. After obtaining ethical clearance from the Institutional Ethics Committee, we used the Mini International Neuropsychiatric Interview to conduct structured diagnostic interview and the Young\'s Mania Rating Scale (YMRS) to assess the severity of mania.
Results: Young\'s Mania Rating Scale scores (Mann–Whitney U = 785.5; p <0.05) and duration of hospital stay (Mann–Whitney U = 587.0; p = 0.04) were significantly different between the two groups. During correlation analysis, negative correlation between age of onset and number of episodes of psychotic mania (p = –0.477; p = 0.008) was seen. A moderate association between duration of hospitalization and YMRS scores (p = 0.331; p = 0.010) was also observed.
Conclusion: Psychotic mania tends to be more severe and needs longer duration of stay in hospital compared to nonpsychotic mania. The negative correlation between age of onset and the number of episodes of psychotic mania highlights the need for specialized early interventions to treat such cases to alter the course of the disorder and improve the socio-occupational impairment.
Kessler RC, Akiskal HS, Ames M, et al. Considering the costs of bipolar depression. Behav Healthc 2007 Jan;27(1):45–47. PMID: 17310917.
Tondo L, Isacsson G, Baldessarini R. Suicidal behaviour in bipolar disorder: risk and Prevention. CNS Drugs 2003;17(7):491–511. DOI: 10.2165/00023210-200317070-00003.
World Health Organization. Reducing risks, promoting healthy life. Geneva: The World Health Report; 2002.
Goodwin FK, Jamison KR. Manic depressive illness. New York: Oxford University Press; 1990.
Keck PE Jr, McElroy SL, Havens JR, et al. Psychosis in bipolar disorder: phenomenology and impact on morbidity and course of illness. Compr Psychiatry 2003;44(4):263–269. DOI: 10.1016/S0010-440X(03)00089-0.
Azorin JM, Akiskal H, Akiskal K, et al. Is psychosis in DSM-IV mania due to severity? The relevance of selected demographic and comorbid social-phobic features. Acta Psychiatr Scand 2007;115(1):29–34. DOI: 10.1111/j.1600-0447.2006.00841.x.
Taylor MA, Abrams R. The phenomenology of mania: a new look at some old patients. Arch Gen Psychiatry 1973;29(4):520–522. DOI: 10.1001/archpsyc.1973.04200040066011.
van Rossum I, Haro JM, Tenback D, et al. Stability and treatment outcome of distinct classes of mania. Eur Psychiatry 2008;23(5):360–367. DOI: 10.1016/j.eurpsy.2008.02.005.
World Health Organization. The ICD-10 classification of mental and behavioral disorders. clinical description and diagnostic guidelines. Geneva: WHO; 1992.
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59 Suppl 20:22–33;quiz 34–57. PMID: 9881538.
Young RC, Biggs JT, Ziegler VE, et al. A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;133:429–435. DOI: 10.1192/bjp.133.5.429.
IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
Kessler RC, Brown RL, Broman CL. Sex differences in psychiatric help-seeking: evidence from four large-scale surveys. J Health Soc Behav 1981 Mar;22(1):49–64. PMID: 7240706.
Yildiz A, Sachs GS. Age onset of psychotic versus non-psychotic bipolar illness in men and in women. J Affect Disord 2003;74(2):197–201. DOI: 10.1016/s0165-0327(02)00003-4.
Kennedy N, Boydell J, Kalidindi S, et al. Gender differences in incidence and age at onset of mania and bipolar disorder over a 35-year period in Camberwell, England. Am J Psychiatry 2005;162(2):257–262. DOI: 10.1176/appi.ajp.162.2.257.
Grover S, Avasthi A, Chakravarty R, et al. Bipolar disorder course and outcome study from India (BiD-CoIN study): sample description and methods. J Affect Disord 2021;280(Pt B):16–23. DOI: 10.1016/j.jad.2020.11.082 [Erratum in: J Affect Disord 2021;281:992. PMID: 33221603].
Carter TD, Mundo E, Parikh SV, et al. Early age at onset as a risk factor for poor outcome of bipolar disorder. J Psychiatr Res 2003;37(4):297–303. DOI: 10.1016/s0022-3956(03)00052-9.
Taylor MA, Abrams R. Early- and late-onset bipolar illness. Arch Gen Psychiatry 1981;38(1):58–61. DOI: 10.1001/archpsyc.1981.01780260060006.
McGlashan TH. Is active psychosis neurotoxic? Schizophr Bull 2006;32(4):609–613. DOI: 10.1093/schbul/sbl032.
Buoli M, Caldiroli A, Cumerlato Melter C, et al. Biological aspects and candidate biomarkers for psychotic bipolar disorder: a systematic review. Psychiatry Clin Neurosci 2016;70(6):227–244. DOI: 10.1111/pcn.12386.
Özyıldırım I, Cakir S, Yazici O. Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder. Eur Psychiatry 2010;25(1):47–51. DOI: 10.1016/j.eurpsy.2009.08.004.
Brunelle J, Consoli A, Tanguy ML, et al. Phenomenology, sociodemographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents: a chart review. Eur Child Adolesc Psychiatry 2009;18:185–193. DOI: 10.1007/s00787-008-0715-7.
Prabhavathy KS, Kuruvilla PK, Ravindren R, et al. Treatment response in nonpsychotic vs psychotic manias: a follow up study from India. Asian J Psychiatr 2017;26:104–108. DOI: 10.1016/j.ajp.2017.01.006. PMID: 28483069.
Buoli M, Caldiroli A, Serati M, et al. Sex steroids and major psychoses: which role for DHEA-S and progesterone. Neuropsychobiology 2016;73(3):178–183. DOI: 10.1159/000444922.
Ong D, Walterfang M, Malhi GS, et al. Size and shape of the caudate nucleus in individuals with bipolar affective disorder. Aust N Z J Psychiatry 2012;46(4):340–351. DOI: 10.1177/0004867412440191.
Nehme E, Obeid S, Hallit S, et al. Impact of psychosis in bipolar disorder during manic episodes Int J Neurosci 2018;128(12):1128–1134. DOI: 10.1080/00207454.2018.1486833.
Carney CP, Jones L, Woolson RF. Medical comorbidity in women and men with schizophrenia: a population‐based controlled study. J Gen Intern Med 2006;21(11):1133–1137. DOI: 10.1111/j.1525-1497.2006.00563.x.
Carlson GA, Goodwin FK. The stages of mania. A longitudinal analysis of the manic episode. Arch Gen Psychiatry 1973;28(2):221–228. DOI: 10.1001/archpsyc.1973.01750320053009.