Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review

Table 6 Demographic and clinical correlates of psychosis in bipolar disorder

Correlates	Studies showing positive association with psychosis	Studies showing inverse association or no association with psychosis1
Younger age	n = 14	n = 48
Female sex	n = 16	n = 51
Single status	n = 11	n = 14
Lower educational levels	n = 9	n = 26
Low income or unemployment	n = 6	n = 14
Ethnic minority status	n = 4	n = 10
Severity of psychotic symptoms in bipolar disorder
Studies showing that psychotic symptoms are less severe in bipolar disorder	Studies showing that psychotic symptoms are more severe in bipolar disorder
n = 20	n = 20
Severity of illness/mood symptoms in psychotic bipolar disorder
Studies showing that the illness/mood symptoms are not more severe in psychotic bipolar disorder	Studies showing that severity of illness/mood symptoms is greater in psychotic bipolar disorder
n = 16	n = 34
Insight and psychotic symptoms in bipolar disorder
Studies showing that psychosis is associated with lack of insight in bipolar disorder	Studies showing that psychosis is not associated with lack of insight in bipolar disorder
n = 15	n = 9
Agitation, aggression and anxiety in psychotic bipolar disorder
Studies showing that agitation, aggression and anxiety are associated with psychosis in bipolar disorder	Studies showing that agitation, aggression and anxiety are not associated with psychosis in bipolar disorder
n = 13	n = 2
Comorbidity and psychotic symptoms in bipolar disorder
Studies showing that psychosis associated with greater comorbidity in bipolar disorder	Studies showing that psychosis is not associated with greater comorbidity in bipolar disorder
n = 21	n = 27

¹Twenty-seven studies found no significant relationships between psychotic bipolar disorder and any of the demographic characteristics. Complete details in Supplementary Tables 8 and 9.