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

Table 7 Impact of psychotic symptoms on the course and outcome of bipolar disorder

Outcome measure	Studies with positive association with psychosis in bipolar disorder	Studies with negative or no association with psychosis in bipolar disorder
Poor overall outcome	n = 38	n = 39
Earlier age of onset	n = 30	n = 36
Persistent or chronic course of illness	n = 23	n = 18
Lack of remission or lack of recovery	n = 12	n = 15
More frequent relapses or recurrences	n =5	n = 5
Greater number of mood episodes	n = 13	n = 19
Lower proportion with rapid cycling	n = 6	n = 6
Longer duration of illness	n = 5	n = 23
Manic polarity of illness	n = 9	n = 6
Seasonal pattern of illness	n = 2	n = 2
More frequent hospitalizations or longer hospital stays	n =26	n = 15
Poor functioning, poor quality of life, or poor functional outcome	n = 45	n = 46
More frequent suicidal attempts or heightened suicidal behavior	n = 14	n = 35
Good response to lithium treatment	n = 5	n = 10
Switch to diagnosis of bipolar disorder	n = 10	-
Poorer outcome with mood-incongruent psychotic symptoms	n = 21	n = 13
Poorer outcome with first-rank symptoms	n = 3	n = 9

Complete details in Supplementary Table 10.