O078 - Clinical and prognostic differences between manic episodes with and without psychotic symptoms: a 5-year retrospective study with a focus on the non-psychotic presentations.
O078
Clinical and prognostic differences between manic episodes with and without psychotic symptoms: a 5-year retrospective study with a focus on the non-psychotic presentations.
H. Andreu Gracia 1,*, A. Giménez-Palomo 1 2 3, L. Olivier 1, I. Ochandiano 1, O. de Juan 1, S. Salmerón 1, E. Vieta 1 2 3, I. Pacchiarotti 1 2 3
1Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, 2Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 3Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Introduction: Psychotic symptoms are frequent during acute episodes of bipolar disorder (BD), particularly in mania, and are traditionally considered a marker of greater severity and worse prognosis. However, data comparing psychotic and non-psychotic mania remain limited and inconsistent.
Objectives: This study aimed to retrospectively examine clinical, therapeutical and 3-year outcome differences between patients hospitalized for mania with and without psychotic symptoms.
Methods: We included all patients admitted for a manic episode to the acute psychiatry unit at Hospital Clínic of Barcelona between 2015 and 2019 (n = 277). Data were extracted from medical records. Patients were followed for 3 years to assess psychiatric emergency department (PED) visits and readmissions. Functional outcomes were also analysed in the BD subgroup (n = 234). Descriptive statistics and survival analyses were used.
Results: Psychotic symptoms were present in 73.6% of the patients and were associated with younger age (p<0.001), earlier onset (p=0.020), poorer insight (p<0.001), higher cannabis use (p=0.018) and manic predominant polarity (p=0006). Non-psychotic patients had more previous admissions for depressive episodes (p=0.003), more previous mixed episodes (p=0.006) and suicide attempts (p=0.002). No significant differences were found in PED visits or readmissions in the next 3 years. Logistic regression identified the number of previous mixed-episode-related admissions as a significant predictor of readmissions (p=0.041), while psychotic symptoms were not associated with either outcome.
Conclusions: While psychotic and non-psychotic mania show clinical and therapeutical differences, psychosis may not predict short-to-medium term outcomes. Non-psychotic mania - which is associated with depressive polarity, mixed features and suicidal behaviour - may indicate a clinically relevant and therapeutically challenging but underrecognized subgroup. These findings call for a nuanced comprehension of the impact of psychosis in mania and multidimensional approaches.
Disclosure of Interest: None Declared