title: Subclinical psychotic experiences and bipolar spectrum features in depression: association with outcome of psychotherapy.
abstract: BACKGROUND
  Subthreshold psychotic and bipolar experiences are common in major depressive disorder (MDD). However, it is unknown if effectiveness of psychotherapy is altered in depressed patients who display such features compared with those without. The current paper aimed to investigate the impact of the co-presence of subclinical psychotic experiences and subclinical bipolar symptoms on the effectiveness of psychological treatment, alone or in combination with pharmacotherapy.
  
  
  METHODS
  In a naturalistic study, patients with MDD (n = 116) received psychological treatment (cognitive behavioural therapy or interpersonal psychotherapy) alone or in combination with pharmacotherapy. Depression and functioning were assessed six times over 2 years. Lifetime psychotic experiences and bipolar symptoms were assessed at the second time point.
  
  
  RESULTS
  Subclinical psychotic experiences predicted more depression over time (β = 0.20, p < 0.002), non-remission [odds ratio (OR) 7.51, p < 0.016] and relapse (OR 3.85, p < 0.034). Subthreshold bipolar symptoms predicted relapse (OR 1.16, p < 0.037).
  
  
  CONCLUSIONS
  In general, subclinical psychotic experiences have a negative impact on the course and outcome of psychotherapy in MDD. Effects of subclinical bipolar experiences were less prominent.
authors: Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: J T W
authors: JT
authors: Wigman
authors: Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: J
authors: J
authors: van Os
authors: Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: L
authors: L
authors: Abidi
authors: Department of Clinical Psychological Science, Research Institute of Experimental Psychopathology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.
authors: M J H
authors: MJ
authors: Huibers
authors: Department of Clinical Psychological Science, Research Institute of Experimental Psychopathology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.
authors: J
authors: J
authors: Roelofs
authors: Department of Clinical Psychological Science, Research Institute of Experimental Psychopathology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands.
authors: A
authors: A
authors: Arntz
authors: Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Republic of Ireland.
authors: I
authors: I
authors: Kelleher
authors: Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors: F P M L
authors: FP
authors: Peeters
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011613:Psychotherapy / Q000379:methods*; D011618:Psychotic Disorders / Q000453:epidemiology / Q000628:therapy*; D012008:Recurrence; D012074:Remission Induction; D016896:Treatment Outcome; D055815:Young Adult