Psychotic features are important for differing heterogeneity of bipolar patients as subtype. Especially combined psychotic symptoms are associated with impaired insight of illness as well as cognitive deficits. We investigated manic prodromes and coping strategies to prodromal signs in bipolar patients with or without psychotic features.
We recruited 72 euthymic bipolar patients (34 psychosis and 38 nonpsychosis) classified by presence of psychotic features at most recent mood episode. All participants were euthymic (HDRS<8, YMRS<6) no psychiatric admission at least 3 months before participation. We used 40-item checklist for examining prodromes. Coping inventory for prodromes of mania (CIPM) were gained. CIPM consist of four subscales, which are Seek Professional Help, Stimulation Reduction, Problem-directed Coping, and Denial or Blame.
In prodromal period, subsyndromal psychotic symptoms were more prevalent in psychotic patients than in nonpsychotic patients (76.5% vs 44.7%, χ2=7.51, p=0.01). However, there were no significant differences of sleep disturbance (76.5% vs. 65.8%), mood change (70.6% vs. 65.8%), psychomotor symptoms (76.5% vs. 73.7%), appetite change (26.5% vs. 42.1%), increased anxiety (55.9% vs. 57.9%) and others (44.1% vs. 44.7%). Psychotic patients showed significantly higher scores in Seek Professional Help (2.33±1.10 vs. 1.82±0.93, p=0.04) and Denial or Blame (2.37±0.81 vs. 1.92±0.75, p=0.02).
Psychotic bipolar patients tended to showed attenuated psychotic symptoms as prodromal features and tried to find professional help although they denied their possible warning signs, compared to nonpsychotic patients. These findings suggest modified psychosocial intervention for relapse prevention in psychotic bipolar patients.