title: The association between psychotic mania, psychotic depression and mixed affective episodes among 14,529 patients with bipolar disorder.
abstract: BACKGROUND
  Psychotic and mixed affective episodes are prevalent in the course of bipolar disorder. Despite many studies on the implications of psychotic mania (PM), psychotic depression (PD) and mixed affective episodes (MAE), relatively little is known about the relationship between the three subtypes. The present study aimed to investigate whether the occurrence of PM, PD and MAE were associated with one another.
  
  
  METHODS
  This is a nationwide register-based, historical prospective cohort study. Data was obtained from the Danish Psychiatric Central Research Register. Subjects were defined as all individuals assigned with an ICD-10 diagnosis of bipolar disorder between January 1st 1994 and December 31st 2010. Potential associations among psychotic and mixed affective episodes were tested by means of logistic regression.
  
  
  RESULTS
  We identified 14,529 individuals with bipolar disorder with lifetime incidences of PM, PD and MAE of 19%, 15% and 17% respectively. We detected significant associations between PM and MAE (Adjusted Odds Ratio (AOR)=1.26, p=0.003), PD and MAE (AOR=1.24, p=0.001), and PM and PD (AOR=1.28, p=0.005).
  
  
  CONCLUSIONS
  Diagnoses were assigned as part of routine clinical practice.
  
  
  CONCLUSIONS
  According to this register-based study, PD, PM and MAE are all associated with one another. This knowledge should be taken into consideration by clinicians when monitoring patients with bipolar disorder and by nosologists when defining the criteria and potential subtypes for mixed affective episodes for the upcoming DSM-5 and ICD-11.
authors.affiliation: Unit For Psychiatric Research, Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark. sdo@rn.dk
authors.forename: Søren Dinesen
authors.initials: SD
authors.lastname: Ostergaard
authors.forename: Aksel
authors.initials: A
authors.lastname: Bertelsen
authors.forename: Jimmi
authors.initials: J
authors.lastname: Nielsen
authors.forename: Ole
authors.initials: O
authors.lastname: Mors
authors.forename: Georgios
authors.initials: G
authors.lastname: Petrides
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000453:epidemiology; D012042:Registries