Predictors of Bipolar Disorder Versus Schizophrenia Diagnosis in a Multicenter First Psychotic Episode Cohort: Baseline Characterization and a 12-Month Follow-Up Analysis

Instructions

Click the red REGISTER button to pay the $10 fee and take the posttest
Click here to return to the JCP CME article.

OVERVIEW

What features may predict bipolar disorder vs schizophrenia in a person with first-episode psychosis? In this journal CME activity, find out which tools could most aid diagnosis.

ABSTRACT

Objective: The aim of this study was to identify predisposing factors and clinical features at baseline that might help predict diagnosis of bipolar disorder vs schizophrenia in a first-episode psychosis (FEP) cohort.

Methods: In this prospective, naturalistic study, we evaluated a cohort of 335 subjects with FEP recruited from April 2009 to April 2012. Baseline features were compared between subjects with a final DSM-IV diagnosis of bipolar disorder and schizophrenia at 12-month follow-up. A binary logistic regression model was used to assess predictors of diagnosis of bipolar disorder at follow-up.

Results: At 12-month follow-up, 47 of the 335 subjects included in the study received the diagnosis of bipolar disorder and 105, of schizophrenia. Subjects with a final diagnosis of bipolar disorder had a higher prevalence of family history of mood disorders (38.2% vs 18.0%, P = .02), better baseline premorbid adjustment (Premorbid Adjustment Scale [PAS]: 38.4 vs 50.6, P < .01) and psychosocial functioning (Functional Assessment Short Test [FAST]: 23.6 vs 33.7, P = .001), better cognitive flexibility (number of perseverative errors on the Wisconsin Card Sorting Test [WCST]: 14.2 vs 19.7, P = .01), more manic symptoms (Young Mania Rating Scale [YMRS]: 14.1 vs 7.3, P < .01), lesser negative symptoms (Positive and Negative Syndrome Scale negative scale [PANSS-N]: 15.0 vs 22.3, P < .001), and shorter duration of untreated psychosis (144.2 vs 194.7 days, P < .01) than subjects with a schizophrenia diagnosis. Binary logistic regression model revealed that lower FAST scores (odds ratio [OR] = 0.956; P = .015), lower PANSS-N scores (OR = 0.93; P = .048), and lower number of perseverative errors on the WCST (OR = 0.946; P = .035) were significantly related to diagnosis of bipolar disorder at follow-up.

Conclusions: In our FEP cohort, better psychosocial functioning, lesser negative symptoms, and better cognitive flexibility were related to diagnosis of bipolar disorder at 12-month follow-up.

To cite: Salagre E, Grande I, Vieta E, et al. Predictors of bipolar disorder versus schizophrenia diagnosis in a multicenter first psychotic episode cohort: baseline characterization and a 12-month follow-up analysis. J Clin Psychiatry. 2020;81(6):19m12996.

To share: https://doi.org/10.4088/JCP.19m12996


Read the whole article at psychiatrist.com here:
Predictors of Bipolar Disorder Versus Schizophrenia Diagnosis in a Multicenter First Psychotic Episode Cohort: Baseline Characterization and a 12-Month Follow-Up Analysis

Target Audience

Psychiatrists

Learning Objectives

Identify patients with first-episode psychosis who have clinical features that are associated with a diagnosis of bipolar disorder as opposed to schizophrenia

Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
11/03/2020
Activity expires: 
12/31/2022
Cost:
$10.00
Rating: 
0

CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.

CME Objective

After studying this article, you should be able to:

• Identify patients with first-episode psychosis who have clinical features that are associated with a diagnosis of bipolar disorder as opposed to schizophrenia

Statement of Need and Purpose

Early diagnosis in bipolar disorder can be challenging due to its heterogeneous clinical presentation, which can be in the form of a first-episode psychosis. Because treatment for bipolar disorder differs from that for schizophrenia, clinicians need education about baseline features that are predictors of a bipolar diagnosis in patients with psychosis.

Release, Expiration, and Review Dates

This educational activity was published in November 2020 and is eligible for AMA PRA Category 1 Credit™ through December 31, 2022. The latest review of this material was October 2020.

Disclosure of off-label usage

The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents or device therapies that is outside US Food and Drug Administration–approved labeling has been presented in this activity.

Funding/support

This study was supported by Ministerio de Economía y Competitividad (ref. ISCIII 2009-2011: PEPs study PI 080208); Instituto de Salud Carlos III, Fondo Europeo de Desarrollo Regional, Unión Europea, “Un manera de hacer Europa”; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), by the CERCA Programme/Generalitat de Catalunya and Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2014SGR441). Dr Vieta acknowledges the support of the Spanish Ministry of Science, Innovation and Universities (PI15/00283) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER); CIBERSAM; and the Comissionat per a Universitats i Recerca del DIUE de la Generalitat de Catalunya to the Bipolar Disorders Group (2017 SGR 1365); and the project SLT006/17/00357, from PERIS 2016-2020 (Departament de Salut). CERCA Programme/Generalitat de Catalunya. Dr Grande acknowledges the support of the Spanish Ministry of Economy, Industry and Competitiveness (PI16/00187, PI19/00954) integrated into the Plan Nacional de I+D+I and cofinanced by the ISCIII-Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER). Dr Salagre is supported by the Instituto de Salud Carlos III through a “Rıo Hortega” contract (CM19/00123) co-financed by the European Social Fund. Dr González-Pinto acknowledges the support of the national grant PI14/01900. Dr Bonnin acknowledges the Departament de Salut de la Generalitat de Catalunya for the PERIS grant (SLT002/16/00331). Dr Ibáñez acknowledges the support of Madrid Regional Govermment (B2017/BMD-3740 AGES-CM 2, and Fondo Social Europeo y Fondo Europeo de Desarrollo Regional, 2014-2020. Dr Balanzá-Martínez is supported by the national grant PI16/01770 (PROBILIFE Study), from the Instituto de Salud Carlos III.

Role of the sponsor

The funding providers had no role in the conduct of the study or the publication of the results.

Previous presentation

Poster presented at the 31st ECNP Congress; October 6–9, 2018; Barcelona, Spain ▪ XXI Congreso Nacional de Psiquiatría; October 18–20, 2018; Granada, Spain.

FACULTY AFFILIATION

Estela Salagre, MD
Bipolar and Depressive Disorders Unit, Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Spain; and Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain

Iria Grande, MD, PhD*
Bipolar and Depressive Disorders Unit, Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Spain; and Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain

Eduard Vieta, MD, PhD*
Bipolar and Depressive Disorders Unit, Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Spain; and Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain

Gisela Mezquida, PhD
Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; and Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, Barcelona, Spain|

Manuel J. Cuesta, MD, PhD
Department of Psychiatry, Complejo Hospitalario de Navarra, Instituto de Investigaciones Sanitarias de Navara, Pamplona, Spain

Carmen Moreno, PhD
Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; and Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain

Miquel Bioque, MD, PhD
Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, Barcelona, Spain; and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain

Antonio Lobo, MD, PhD
Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; and Department of Medicine and Psychiatry, Zaragoza University, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain

Ana González-Pinto, MD, PhD
Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; and Department of Psychiatry, Hospital Universitario de Álava, University of the Basque Country (UPV/EHU), Vitoria, Spain

Dolores María Moreno, MD, PhD
Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; and Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain

Iluminada Corripio, MD, PhD
Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; and Department of Psychiatry, Hospital de Sant Pau, Barcelona, Spain

Norma Verdolini, MD, PhD
Bipolar and Depressive Disorders Unit, Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Spain; Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain

Josefina Castro-Fornieles, MD, PhD
Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain; and Department of Child and Adolescent Psychiatry and Psychology, 2017SGR881, Institute of Neurosciences, Hospital Clinic of Barcelona, University of Barcelona, Spain

Anna Mané, MD, PhD
Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; and Hospital del Mar Medical Research Institute, Autonomous University of Barcelona, Barcelona, Spain

Justo Pinzon-Espinosa, MD
Bipolar and Depressive Disorders Unit, Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Spain

Caterina del Mar Bonnin, PhD
Bipolar and Depressive Disorders Unit, Psychiatry and Psychology Department of the Hospital Clínic, Institute of Neuroscience, University of Barcelona, IDIBAPS, Barcelona, Spain; and Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain

Miquel Bernardo, MD, PhD
Biomedical Research Networking Center for Mental Health (CIBERSAM), Barcelona, Spain; Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, University of Barcelona, Barcelona, Spain; and Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain

PEPs Group
PEPs Group members are listed below

*Corresponding authors: Eduard Vieta, MD, PhD, and Iria Grande, MD, PhD, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clinic of Barcelona, Villarroel, 170, 08036 Barcelona, Spain (evieta@clinic.cat and igrande@clinic.cat).

FINANCIAL DISCLOSURE

All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief of The Journal of Clinical Psychiatry, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; has been a member of the Steering Committee for Educational Activities for Medscape; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships.

Dr Grande has received grants and served as consultant, advisor, or CME speaker for Angelini, AstraZeneca, CasenRecordati, Ferrer, Janssen Cilag, Lundbeck, Lundbeck-Otsuka, SEI Healthcare, Spanish Ministry of Economy and Competitiveness, and Instituto de Salud Carlos III (ISCIII). Dr Vieta has received grants and served as consultant, advisor, or CME speaker for AB-Biotics, Abbott, Allergan, Angelini, Dainippon Sumitomo Pharma, Galenica, Janssen, Lundbeck, Novartis, Otsuka, Sage, Sanofi-Aventis, and Takeda. Dr Mezquida reports grants from European Union Funds, ISCIII, and Spanish Ministry of Economy and Competitiveness and declares honoraria for participating in advisory boards, data safety monitory boards, or symposia from Janssen, Servier, Nuvelution, Otsuka, Lundbeck, and Angelini. Dr Bioque has received honoraria for talks and consultancy from Adamed, Lundbeck, and Otsuka; received honoraria for consultancy from Ferrer; received research support and honoraria for talks and consultancy from Janssen-Cilag; received honoraria for talks from Neuraxpharm; and received a research prize from Pfizer. Dr González-Pinto has received grants from and served as consultant, advisor, or CME speaker for Janssen-Cilag, Lundbeck, Otsuka, Pfizer, Sanofi-Aventis, Exeltis, Ferrer, Nutrición Médica, Angelini, the Spanish Ministry of Science and Innovation (CIBERSAM), the Ministry of Science (Instituto de Salud Carlos III), the Basque Government, and the Stanley Medical Research Institute. Dr D. M. Moreno has received honoraria from Rubió and Rovi. Dr Pinzon-Espinosa has served as a CME speaker for Lundbeck-Otsuka. Dr Bernardo has been a consultant for, received grant/research support and honoraria from, and been on the speakers/advisory board of AB-Biotics, Adamed, Angelini, Casen Recordati, Eli Lilly, Janssen-Cilag, Lundbeck, Otsuka, Takeda, and Somatics and has obtained research funding from the Ministry of Education, Culture and Sport, the Spanish Ministry of Economy, Industry and Competitiveness (CIBERSAM), by the Government of Catalonia, Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017SGR1355), Foundation European Group for Research In Schizophrenia (EGRIS), and the 7th Framework Program of the European Union. Drs SalagreCuestaC. MorenoLoboCorripioVerdoliniCastro-FornielesMané, and Bonnin and the remaining members of the PEPs group have no personal affiliations or financial relationships with any commercial interest to disclose relative to the article.

PEPs Group

Bibiana Cabrera, PhD; Silvia Amoretti, PhD; Laura Pina-Camacho, MD, PhD; Elisa Rodriguez, PsyD; Anna Alonso-Solís, PhD; Mireia Rabella, PhD; Purificación López, MD, PhD; Iñaki Zorrilla, MD, PhD; Concepción De-la-Cámara, MD, PhD; Fe Barcones, MD, PhD; Julio Sanjuán, MD, PhD; Esther Lorente-Rovira, PhD; Patricia-Carolina Garnier, MD; Purificación Salgado, MD; Jose Sanchez-Moreno, PsyD; Susana Gomes-da-Costa, MD; Immaculada Baeza, MD, PhD; Elena de la Serna, PhD; Fernando Contreras-Fernández, MD, PhD; Cristina Saiz-Masvidal; María Paz García-Portilla, MD, PhD; Lorena De la Fuente-Tomás, PsyD; Miguel Gutiérrez-Fraile, MD, PhD; Mónica Dompablo, PsyD; Roberto Rodriguez-Jiménez, MD, PhD; Judith Usall, MD, PhD; Anna Butjosa, PhD; Salvador Sarró, MD, PhD; Edith Pomarol-Clotet, MD, PhD; Ángela Ibáñez, MD, PhD; Ana Sánchez-Torres, PhD; and Vicent Balanzá-Martínez, MD, PhD

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
$10.00
Please login or register to take this activity.

Register for free on our site to participate in this and many free CME courses. There is a $10 processing fee for this activity.