title: Social and symptomatic outcomes of first-episode bipolar psychoses in an early intervention service.
abstract: OBJECTIVE
  We aimed to establish the relative proportions of all diagnoses in people aged 14-35 years presenting to an early intervention in psychosis service, and to compare demographic variables, symptoms and outcomes between the bipolar psychoses and other psychoses at 3-6 months and 1 year post referral.
  
  
  METHODS
  Prospective 3- to 6-month diagnostic and symptomatic assessments were carried out. Diagnoses were established using the Diagnostic Interview for Psychoses - Diagnostic Module. Symptoms and outcomes were assessed using standardized instruments at 3-6 months and 1 year. Bipolar diagnoses were grouped together in a bipolar group (n=16) and compared with all other diagnoses, in a non-bipolar group (n=62). Parallel analysis was carried out using groups of lifetime elevated, expansive or irritable mood (n=32) and no lifetime elevated, expansive or irritable mood (n=46).
  
  
  RESULTS
  Bipolar disorders account for 20.5% of all new presentations to our service. Differences in outcomes over the range of psychotic diagnoses relate to early presence of negative symptoms. Psychoses with bipolar diagnoses or lifetime elevated, expansive or irritable mood showed lower rates of negative symptoms than other psychoses and had a higher quality of life and higher function at 3-6 months and 1 year.
  
  
  CONCLUSIONS
  Planning for future early intervention services should take the high rate of affective psychoses and their need for diagnosis-specific, evidence-based treatments into account. Lifetime elevated, expansive or irritable mood may predict improved outcomes in early psychoses, possibly mediated by lower levels of negative symptoms.
authors.affiliation: Early Intervention Service, and University of East Anglia, Norwich, UK. iain.macmillan@nwmhp.nhs.uk
authors.forename: Iain
authors.initials: I
authors.lastname: Macmillan
authors.forename: Lawrence
authors.initials: L
authors.lastname: Howells
authors.forename: Kedar
authors.initials: K
authors.lastname: Kale
authors.forename: Corinna
authors.initials: C
authors.lastname: Hackmann
authors.forename: Gavin
authors.initials: G
authors.lastname: Taylor
authors.forename: Katherine
authors.initials: K
authors.lastname: Hill
authors.forename: Steve
authors.initials: S
authors.lastname: Bradford
authors.forename: David
authors.initials: D
authors.lastname: Fowler
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000628:therapy; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis; D011788:Quality of Life; D012720:Severity of Illness Index; D012917:Social Adjustment; D016896:Treatment Outcome