Lifetime presence of psychotic symptoms in bipolar disorder is associated with less favorable socio-demographic and certain clinical features

Abstract Background The presence of psychotic symptoms in bipolar disorder (BD) is considered a feature of higher severity of illness and, in particular, of manic episodes in bipolar I disorder (BD I). However, the possibility to apply the “with psychotic features” specifier to major depressive episodes in either bipolar II disorder (BD II) or BD I highlights the need for additional research in this area. Methods The present study assessed the lifetime presence of psychotic symptoms and related socio-demographic and clinical features in a large sample of BD patients ( N  = 360), with (BDPs, N  = 207) and without a lifetime history of psychosis (BDNPs, N  = 153). Results An overall less favorable socio-demographic profile was observed in BDPs vs BDNPs. In terms of clinical variables, BDPs vs BDNPs had: earlier age at onset (27.7 ± 10.5 vs 30.1 ± 12.3 years; p  = 0.02), higher rates of BD I diagnosis (95.7% vs 45.8%; p p p p  = 0.002), more lifetime hospitalizations (3.8 ± 6.1 vs 2 ± 3; p  = 0.002) and involuntary commitments (1 ± 1.9 vs 0.1 ± 0.4; p p  = 0.001), more current antipsychotic use (90.1% vs 70.9%; p p p  = 0.04), lower rates of comorbid anxiety disorders (23.9% vs 38.2%; p  = 0.005), and antidepressant use (19.4% vs 56.6%; p Conclusions The present findings indicate an overall worse profile of socio-demographic and certain clinical characteristics associated with the lifetime presence of psychotic symptoms in bipolar patients.