Axis I comorbidity in bipolar disorder with psychotic features

Background Axis 1 comorbidities are prevalent among patients with severe bipolar disorder but the clinical and psychopathological implications are not clear. Aims To investigate characteristics of four groups of patients categorised as follows: substance abuse only (group I), substance abuse associated with other Axis 1 disorders (group 2), non-substance-abuse Axis 1 comorbidity (group 3), no psychiatric comorbidity (group 4). Method Consecutive patients with bi polar disorder with psychotic features (n=125) were assessed using the Structured Clinical Interview for DSM-III-R - patient version, and several psychopathological scales. Results By comparison with group 4, group 1 had a higher risk of having mood-incongruent delusions, group 2 had an earlier age at onset of mood disorder, a more frequent onset with a mixed state and a higher risk of suicide, and group 3 had more severe anxiety and a better awareness of illness. Conclusions Substance-abuse,nonsubstance-abuse Axis ` comorbidity and their reciprocal association are associated with different characteristics of bipolar disorder. Declaration of interest This study was supported by funds from the Department of Psychiatry, University of Pisa.