The characteristics of psychotic features in bipolar disorder

Annet H. van Bergen, Sanne Verkooijen, Annabel Vreeker, Lucija Abramovic, Manon H. Hillegers, Annet T. Spijker, Erik Hoencamp, Eline J. Regeer, Stefan E. Knapen, Rixt F. Riemersma-van der Lek, Robert Schoevers, Anja W. Stevens, Peter F. J. Schulte, Ronald Vonk, Rocco Hoekstra, Nico J. van Beveren, Ralph W. Kupka, Iris E. C. Sommer, Roel A. Ophoff, René S. KahnMarco P. M. Boks

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BackgroundIn a large and comprehensively assessed sample of patients with bipolar disorder type I (BDI), we investigated the prevalence of psychotic features and their relationship with life course, demographic, clinical, and cognitive characteristics. We hypothesized that groups of psychotic symptoms (Schneiderian, mood incongruent, thought disorder, delusions, and hallucinations) have distinct relations to risk factors.MethodsIn a cross-sectional study of 1342 BDI patients, comprehensive demographical and clinical characteristics were assessed using the Structured Clinical Interview for DSM-IV (SCID-I) interview. In addition, levels of childhood maltreatment and intelligence quotient (IQ) were assessed. The relationships between these characteristics and psychotic symptoms were analyzed using multiple general linear models.ResultsA lifetime history of psychotic symptoms was present in 73.8% of BDI patients and included delusions in 68.9% of patients and hallucinations in 42.6%. Patients with psychotic symptoms showed a significant younger age of disease onset (β = -'0.09, t = -'3.38, p = 0.001) and a higher number of hospitalizations for manic episodes (F11 338 = 56.53, p < 0.001). Total IQ was comparable between groups. Patients with hallucinations had significant higher levels of childhood maltreatment (β = 0.09, t = 3.04, p = 0.002).ConclusionsIn this large cohort of BDI patients, the vast majority of patients had experienced psychotic symptoms. Psychotic symptoms in BDI were associated with an earlier disease onset and more frequent hospitalizations particularly for manic episodes. The study emphasizes the strength of the relation between childhood maltreatment and hallucinations but did not identify distinct subgroups based on psychotic features and instead reported of a large heterogeneity of psychotic symptoms in BD.
Original languageEnglish
Pages (from-to)2036-2048
Number of pages13
JournalPsychological Medicine
Issue number12
Early online date2018
Publication statusPublished - 1 Sept 2019


  • Childhood trauma
  • Schneiderian symptoms
  • cognitive functioning
  • delusions
  • formal thought disorder
  • hallucinations
  • mood incongruent symptoms
  • psychosis

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