title: Differentiating schizoaffective and bipolar I disorder in first-episode psychotic mania.
abstract: OBJECTIVE
  This study aims to differentiate schizoaffective disorder (SAD) and bipolar-I-disorder (BD) in first-episode psychotic mania (FEPM).
  
  
  METHODS
  All 134 patients from an epidemiological first-episode psychosis cohort (N=786) with FEPM and an 18-month follow-up final diagnosis of SAD (n=36) or BD (n=98) were assessed with respect to pre-treatment, baseline and outcome differences. Second, patients with baseline BD who shifted (shifted BD) or did not shift to SAD (stable BD) over the follow-up period were compared regarding pre-treatment and baseline differences.
  
  
  RESULTS
  SAD patients displayed a significantly longer duration of untreated psychosis (DUP; effect size r=0.35), a higher illness-severity at baseline (r=0.20) and more traumatic events (Cramer-V=0.19). SAD patients displayed a significantly higher non-adherence rate (Cramer-V=0.19); controlling for time in treatment and respective baseline scores, SAD patients had significantly worse illness severity (CGI-S; partial η²=0.12) and psychosocial functioning (GAF; partial η(2)=0.07) at 18-months, while BD patients were more likely to achieve remission of positive symptoms (OR=4.9, 95% CI=1.8-13.3; p=0.002) and to be employed/occupied (OR=7.7, 95% CI=2.4-24.4, p=0.001). The main discriminator of stable and shifted BD was a longer DUP in patients shifting from BD to SAD.
  
  
  CONCLUSIONS
  It is difficult to distinguish BD with psychotic symptoms and SAD in patients presenting with FEPM. Longer DUP is related to SAD and to a shift from BD to SAD. Compared to BD, SAD had worse outcomes and higher rates of non-adherence with medication. Despite these differences, both diagnostic groups need careful dimensional assessment and monitoring of symptoms and functioning in order to choose the right treatment.
authors: Psychosis Early Detection and Intervention Centre-PEDIC, Centre for Psychosocial Medicine, Department for Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Germany. d.schoettle@uke.de
authors: Daniel
authors: D
authors: Schöttle
authors: Benno G
authors: BG
authors: Schimmelmann
authors: Philippe
authors: P
authors: Conus
authors: Sue M
authors: SM
authors: Cotton
authors: Chantal
authors: C
authors: Michel
authors: Patrick D
authors: PD
authors: McGorry
authors: Anne
authors: A
authors: Karow
authors: Dieter
authors: D
authors: Naber
authors: Martin
authors: M
authors: Lambert
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D055815:Young Adult