Clinical correlates of acute bipolar depressive episode with psychosis

Marco Antonio Caldieraro, Louisa G. Sylvia, Steven Dufour, Samantha Walsh, Jessica Janos, Dustin J. Rabideau, Masoud Kamali, Melvin G. McInnis, William V. Bobo, Edward S. Friedman, Keming Gao, Mauricio Tohen, Noreen A. Reilly-Harrington, Terence A. Ketter, Joseph R. Calabrese, Susan L. McElroy, Michael E. Thase, Richard C. Shelton, Charles L. Bowden, James H. KocsisThilo Deckersbach, Andrew A. Nierenberg

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background Psychotic bipolar depressive episodes remain remarkably understudied despite being common and having a significant impact on bipolar disorder. The aim of this study is to identify the characteristics of depressed bipolar patients with current psychosis compared to those without psychosis. Methods We used baseline data of a comparative effectiveness study of lithium and quetiapine for bipolar disorder (the Bipolar CHOICE study) to compare demographic, clinical, and functioning variables between those with and without psychotic symptoms. Of the 482 participants, 303 (62.9%) were eligible for the present study by meeting DSM-IV criteria for an acute bipolar depressive episode. Univariate analyses were conducted first, and then included in a model controlling for symptom severity. Results The sample was composed mostly of women (60.7%) and the mean age was 39.5±12.1 years. Psychosis was present in 10.6% (n=32) of the depressed patients. Psychotic patients had less education, lower income, and were more frequently single and unemployed. Psychosis was also associated with a more severe depressive episode, higher suicidality, more comorbid conditions and worse functioning. Most group differences disappeared when controlling for depression severity. Limitations Only outpatients were included and the presence of psychosis in previous episodes was not assessed. Conclusion Psychosis during bipolar depressive episodes is present even in an outpatient sample. Psychotic, depressed patients have worse illness outcomes, but future research is necessary to confirm if these outcomes are only associated with the severity of the disorder or if some of them are independent of it.

Original languageEnglish (US)
Pages (from-to)29-33
Number of pages5
JournalJournal of Affective Disorders
StatePublished - Aug 1 2017


  • Bipolar depression
  • Bipolar disorder
  • Psychosis

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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