Abstract
Background: Dissociative symptoms are under recognized and scarcely studied by clinicians and researchers in patients with bipolar disorder (BD). We examined the relationship between dissociative symptoms and the psychotic features in patients with BD and assessed clinical and socio-demographic characteristics more frequently associated with dissociative symptoms and treatment response.Methods: Participants were 100 adult outpatients with BD. They were screened with semi-structured interview to collect socio-demographic and clinical characteristics; the Dissociative Experiences Scale-II (DES-II) and the ALDA scale were used to assess dissociative psychopathologies and response to treatment with mood stabilizers, respectively.Results: DES score (mean 31.7 ± 21.7) correlated with clinical variables, BD features, and course of illness. Psychotic symptoms, mixed features, and previous suicide attempts significantly predicted DES score [F(3, 47) = 39.880, p < 0.001, R2 corrected = 0.713]. Dissociative symptoms were inversely correlated with poor response to treatment (r = −0.593; p < 0.001).Limitations: Cross-sectional design with a small sample and backward clinical assessment of psychotic symptoms.Conclusions: Dissociative phenomena are closely related to the presence of psychotic symptoms, mixed features, and previous suicide attempts in BD, especially in BD-I. Given the close association between dissociative and psychotic symptoms, this association could represent a diagnostic indicator of BD-I that may guide the clinician to plan the most appropriate treatment.
Highlights
Dissociative symptomatology includes a variety of processes and phenomena along a continuum from adaptive coping strategies to more pathological states [1]
Patients were included in the study if they met the following criteria: [1] age between 18 and 65 years, [2] diagnosis of type-I (BD-I) or type-II (BD-II) bipolar disorder according to the Diagnostic and Statistical Manual of Mental Disorders-fifth edition (DSM-5) [2] clinically stabilized
The main finding of our study is the presence of a stable correlation between dissociative symptoms psychotic symptom, mixed features, and previous suicides attempts in BD
Summary
Dissociative symptomatology includes a variety of processes and phenomena along a continuum from adaptive coping strategies to more pathological states [1]. The “trauma theory” considers dissociation as the coping strategy adopted to deal with severe anxiety symptoms associated with traumatic experiences [3,4,5]. Current evidence suggests that the assessment of dissociative symptoms could be useful in differentiating patients with BD from those with unipolar major depression during depressive episodes. Available data suggest that the presence of dissociative symptoms is considered a marker of poor treatment response in BD [15]. Despite dissociative symptoms can have a potential impact on the psychopathological burden of patients with BD, only a few studies have assessed the relationship between dissociative and psychotic symptoms and treatment response to mood stabilizers. We examined the relationship between dissociative symptoms and the psychotic features in patients with BD and assessed clinical and socio-demographic characteristics more frequently associated with dissociative symptoms and treatment response
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