Psychotic Bipolar Disorder

  • Massimiliano Buoli
  • Alice Caldiroli


Psychotic symptoms are considered a clinical predictor of poor outcome in bipolar disorder (BD). The misdiagnosis of psychotic BD (BD-P) with schizophrenia, schizoaffective disorder, or delusional disorder is very common. The identification of biological markers for BD-P would contribute to establish an early diagnosis and to define a proper treatment, to improve outcome of BD-P patients.

A case of a patient suffering from BD-P has been described, focusing on neuroimaging, neuropsychological, and inflammation data that could be considered potential biomarkers of BD-P.

The patient was a 36-year-old female. During her two hospitalizations, inflammatory and metabolic markers were all normal, except for lower plasma levels of vitamin A. After giving her written informed consent, epigenetic tests were performed, showing a significantly different expression of some miRNAs than healthy controls (HC). The magnetic resonance imaging (MRI) showed hypoplasia of the cerebellar vermis and a small left peritrigonal area of hyperintensity in T2 sequence. The only neuropsychological deficit appeared in the motor task. The positron emission tomography (PET) showed a bilateral hypermetabolism in the frontal cortex, cingulate, and striatum.

This case demonstrated that biological markers may be useful to predict outcome of psychotic bipolar patients.


Bipolar disorder Psychotic symptoms Biomarkers 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Massimiliano Buoli
    • 1
  • Alice Caldiroli
    • 1
  1. 1.Department of Psychiatry, Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly

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