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Psychotic Bipolar Disorder

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Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches

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Abstract

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.

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Author information

Authors and Affiliations

  1. Department of Psychiatry, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Massimiliano Buoli & Alice Caldiroli

Authors
  1. Massimiliano Buoli
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  2. Alice Caldiroli
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Editor information

Editors and Affiliations

  1. Department of Neuroscience and Mental Health, IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    Alfredo Carlo Altamura

  2. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy, IRCCS “E. Medea” Scientific Institute, Bosisio Parini (Lc), Italy

    Paolo Brambilla

Self-Assessment

Self-Assessment

  1. 1.

    What is the prevalence of bipolar disorder?

    • (a) 5%

    • (b) 20%

    • (c) 80%

    • (d) 1–2%

    • (e) 10%

  2. 2.

    Which abnormality has been found in manic BD patients?

    • (a) Increased BDNF levels

    • (b) Increased inflammatory markers

    • (c) Decreased inflammatory markers

    • (d) Increased serum antioxidants levels

    • (e) Decreased BDNF levels

  3. 3.

    Psychotic bipolar patients present:

    • (a) Worse prognosis than unipolar and BD-NP patients

    • (b) Better prognosis than unipolar and BD-NP patients

    • (c) Worse prognosis than SKZ patients

    • (d) Better prognosis than schizoaffective patients

    • (e) We do not have data about BD-P patients’ prognosis

  4. 4.

    Identification of biological markers for BD-P:

    • (a) Would hinder the diagnostic and therapeutic process

    • (b) Could help patients to decide independently which treatment is the best

    • (c) Would help clinicians to promptly diagnose the disorder and to properly identify the treatment

    • (d) Could help clinicians to decide independently which treatment is the best

    • (e) Would hinder the clinical staging processing, worsening outcome in the long term

  5. 5.

    Vitamin A (retinol) is:

    • (a) The forerunner of beta-carotene

    • (b) An enzymatic antioxidant

    • (c) Fundamental for metabolism of lipids and proteins

    • (d) A cholesterol derivative

    • (e) A nonenzymatic antioxidant

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Buoli, M., Caldiroli, A. (2019). Psychotic Bipolar Disorder. In: Altamura, A., Brambilla, P. (eds) Clinical Cases in Psychiatry: Integrating Translational Neuroscience Approaches. Springer, Cham. https://doi.org/10.1007/978-3-319-91557-9_4

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  • DOI: https://doi.org/10.1007/978-3-319-91557-9_4

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