Affective dimensions as a diagnostic tool for bipolar disorder in first psychotic episodes.
OBJECTIVE
To examine the predictive diagnostic value of affective symptomatology in a first-episode psychosis (FEP) sample with 5 years' follow-up.


METHODS
Affective dimensions (depressive, manic, activation, dysphoric) were measured at baseline and 5 years in 112 FEP patients based on a factor structure analysis using the Young Mania Rating Scale and Hamilton Depression Rating Scale. Patients were classified as having a diagnosis of bipolar disorder at baseline (BDi), bipolar disorder at 5 years (BDf), or "other psychosis". The ability of affective dimensions to discriminate between these diagnostic groups and to predict a bipolar disorder diagnosis was analysed.


RESULTS
Manic dimension score was higher in BDi vs. BDf, and both groups had higher manic and activation scores vs. "other psychosis". Activation dimension predicted a bipolar diagnosis at 5 years (odds ratio=1.383; 95% confidence interval, 1.205-1.587; P=0.000), and showed high levels of sensitivity (86.2%), specificity (71.7%), positive (57.8%) and negative predictive value (90.5%). Absence of the manic dimension and presence of the depressive dimension were both significant predictors of an early misdiagnosis.


CONCLUSIONS
The activation dimension is a diagnostic predictor for bipolar disorder in FEP. The manic dimension contributes to a bipolar diagnosis and its absence can lead to early misdiagnosis.
Department of Psychiatry, Basurto Hospital, EHU/UPV, Bilbao, Spain.
M
M
Arrasate
CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain.
I
I
González-Ortega
CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain.
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Alberich
CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain.
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M
Gutierrez
CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain.
M
M
Martínez-Cengotitabengoa
CIBERSAM, Araba Mental Health, Vitoria-Gasteiz, Spain.
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F
Mosquera
CIBERSAM, EMBREC, Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, IDIBAPS, Barcelona, Spain.
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Cruz
Department of Psychiatry, Basurto Hospital, EHU/UPV, Bilbao, Spain.
M A
MA
González-Torres
EMBREC, Department of Psychiatry, Paris, France.
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C
Henry
CIBERSAM, EMBREC, Department of Psychiatry, Araba University Hospital - Santiago, EHU/UPV, Vitoria-Gasteiz, Spain. Electronic address: anamaria.gonzalez-pintoarrillaga@osakidetza.net.
A
A
González-Pinto
D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000523:psychology*; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D015331:Cohort Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D011618:Psychotic Disorders / Q000209:etiology / Q000523:psychology*; D012680:Sensitivity and Specificity; D055815:Young Adult
Activation; Affective; Bipolar; Dimension; First psychosis