Acta Psychiatr Scand. 2025 Nov 30. doi: 10.1111/acps.70049. Online ahead of print.
ABSTRACT
INTRODUCTION: Psychotic symptoms are frequent during acute episodes of bipolar disorder (BD), particularly in mania, and are traditionally considered a marker of greater severity and worse prognosis. However, data comparing psychotic and nonpsychotic mania remain limited and inconsistent.
OBJECTIVES: This study aimed to retrospectively examine clinical, therapeutical and 3-year outcome differences between patients hospitalized for mania with and without psychotic symptoms.
METHODS: We included all patients admitted for a manic episode to the acute psychiatry unit at Hospital Clínic of Barcelona between 2015 and 2019 (n = 277). Data were extracted from medical records. Patients were followed for 3 years to assess psychiatric emergency department (PED) visits and readmissions. Functional outcomes were also analyzed in the BD subgroup (n = 234). Descriptive statistics and survival analyses were used.
RESULTS: Psychotic symptoms were present in 73.6% of the patients and were associated with younger age (p < 0.001), earlier onset (p = 0.020), poorer insight (p < 0.001), higher cannabis use (p = 0.018) and manic predominant polarity (p = 0006). Non-psychotic patients had more previous admissions for depressive episodes (p = 0.003), more previous mixed episodes (p = 0.006) and suicide attempts (p = 0.002). No significant differences were found in PED visits or readmissions in the next 3 years. Logistic regression identified the number of previous mixed-episode-related admissions as a significant predictor of readmissions (p = 0.041), while psychotic symptoms were not associated with either outcome.
CONCLUSIONS: While psychotic and non-psychotic mania show clinical and therapeutical differences, psychosis may not predict short- to medium-term outcomes. Non-psychotic mania-which is associated with depressive polarity, mixed features and suicidal behaviour-may indicate a clinically relevant and therapeutically challenging but underrecognized subgroup. These findings call for a nuanced comprehension of the impact of psychosis in mania and multidimensional approaches.
PLoS One. 2026 May 20;21(5):e0345048. doi: 10.1371/journal.pone.0345048. eCollection 2026.ABSTRACTSocial norms define what is acceptable and appropriate for women and men, boys and girls, in a...
J Healthc Manag. 2026 May-Jun 01;71(3):199-211. doi: 10.1097/JHM-D-24-00249.ABSTRACTGOAL: Violence against psychiatric healthcare workers in inpatient units is prevalent and often the result of a series...
Horm Behav. 2026 May 20;182:105949. doi: 10.1016/j.yhbeh.2026.105949. Online ahead of print.ABSTRACTSocial play is a rewarding behavior shown across juvenile mammalian species and is important for...
JMIR Form Res. 2026 May 20;10:e64409. doi: 10.2196/64409.ABSTRACTBACKGROUND: Quality of life (QOL) is an important aspect of every chronic disease, including interstitial lung disease (ILD)....
JMIR Form Res. 2026 May 20;10:e86698. doi: 10.2196/86698.ABSTRACTBACKGROUND: Somatic symptom disorder (SSD) is a mental disorder marked by persistent somatic symptoms and maladaptive health-related thoughts,...
JMIR Form Res. 2026 May 20;10:e90532. doi: 10.2196/90532.ABSTRACTBACKGROUND: Simple behavioral and cognitive actions can reduce symptoms of anxiety and depression. However, there is limited research...
