OBJECTIVE: The aim of this study was to determine the significance of
mood congruence of psychotic features in mania as a predictor of outcome.
METHOD: Fifty-four patients with bipolar disorder were followed
prospectively for 4 years after recovery from an episode of mania with
psychotic features. Assessments of residential and occupational status,
interepisode symptoms, and episode recurrences were made at 6 and 48 months
after recovery. Categorical outcomes were evaluated by logistic regression
and recurrence risk with survival analysis. RESULTS: Mood-incongruent
psychotic features during the index manic episode predicted a shorter time
in remission at 4 years (hazard ratio = 2.6), and Schneiderian first-rank
symptoms predicted poor residential status at 4 years (odds ratio = 20.1).
CONCLUSIONS: Differentiation of mood congruence of psychotic features in
mania evidently has prognostic validity and, therefore, has utility as a