• Major psychiatric illness
• Multiplex families
• Siblings
• Socio-demographic characteristics

• Humans
• Male
• Female
• Siblings
• Adult
• India
• Educational Status
• Employment/statistics & numerical data
• Bipolar Disorder
• Schizophrenia
• Middle Aged
• Obsessive-Compulsive Disorder
• Substance-Related Disorders/epidemiology
• Young Adult
• Marital Status/statistics & numerical data
• Mental Disorders/epidemiology
• Marriage/statistics & numerical data

• adolescent
• bibliometric
• biological biomarkers
• bipolar disorder
• clinical features
• diagnosis
• major depressive disorder

• National Natural Science Foundation of China

Lifetime psychotic symptoms are present in over half of the patients with bipolar disorder (BD) and can have an adverse effect on its course, outcome, and treatment. However, despite a considerable amount of research, the impact of psychotic symptoms on BD remains unclear, and there are very few systematic reviews on the subject.

To examine the extent of psychotic symptoms in BD and their impact on several aspects of the illness.

The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. An electronic literature search of six English-language databases and a manual search was undertaken to identify published articles on psychotic symptoms in BD from January 1940 to December 2021. Combinations of the relevant Medical Subject Headings terms were used to search for these studies. Articles were selected after a screening phase, followed by a review of the full texts of the articles. Assessment of the methodological quality of the studies and the risk of bias was conducted using standard tools.

This systematic review included 339 studies of patients with BD. Lifetime psychosis was found in more than a half to two-thirds of the patients, while current psychosis was found in a little less than half of them. Delusions were more common than hallucinations in all phases of BD. About a third of the patients reported first-rank symptoms or mood-incongruent psychotic symptoms, particularly during manic episodes. Psychotic symptoms were more frequent in bipolar type I compared to bipolar type II disorder and in mania or mixed episodes compared to bipolar depression. Although psychotic symptoms were not more severe in BD, the severity of the illness in psychotic BD was consistently greater. Psychosis was usually associated with poor insight and a higher frequency of agitation, anxiety, and hostility but not with psychiatric comorbidity. Psychosis was consistently linked with increased rates and the duration of hospitalizations, switching among patients with depression, and poorer outcomes with mood-incongruent symptoms. In contrast, psychosis was less likely to be accompanied by a rapid-cycling course, longer illness duration, and heightened suicidal risk. There was no significant impact of psychosis on the other parameters of course and outcome.

Though psychotic symptoms are very common in BD, they are not always associated with an adverse impact on BD and its course and outcome.

• Psychotic symptoms
• Bipolar disorder
• Extent
• Impact

• psychiatry
• psychology
• psychotic disorders
• schizophrenia
• terminology

This study aimed to investigate the differences in the serum levels of glucose, lipid, and thyroid function markers between unipolar and bipolar depressed patients, as well as the effect of anhedonia and suicidal thoughts on the levels of these biochemical parameters.

A total of 287 unmedicated depressed patients from January 2016 to December 2017 were included in this study, including 92 bipolar depressions and 195 unipolar depressions. Anhedonia was determined using the item 32 of Symptom Checklist (SCL-90). Suicide ideation was assessed by item 15 of SCL-90.

The bipolar group had significantly lower lipid levels (including triglycerides, cholesterol, low-density lipoprotein cholesterol [LDL], very low-density lipoprotein cholesterol [VLDL]) and insulin resistance index but higher levels of prolactin, low triiodothyronine (T3) and free T3 (FT3) as well as higher incidence of anhedonia as compared with the unipolar group. Depressed patients with anhedonia had significantly higher LDL level than those without anhedonia. Depressed patients with suicidal thoughts had cholesterol and high-density lipoprotein cholesterol (HDL) level. The above-mentioned differences were confirmed by logistic regression analysis. Receiver operating characteristic curve (ROC) analysis showed that the area under the ROC curve (AUC) ranged from 0.546 to 0.685.

Triglycerides, cholesterol, LDL, VLDL T3, FT3 levels were significantly different between unipolar and bipolar depressed patients, which might have the potential to be the markers for differential diagnosis. Patients with anhedonia had lower LDL level, while patients with suicidal thoughts had higher levels of cholesterol and HDL as compared with the corresponding control groups.

• Anhedonia
• Bipolar depression
• Lipid profile
• Suicidal thoughts
• Unipolar depression

• Adult
• Biomarkers/metabolism
• Bipolar Disorder/physiopathology
• Cross-Sectional Studies
• Female
• Humans
• India/epidemiology
• Male
• Metabolic Syndrome/diagnosis
• Metabolic Syndrome/epidemiology
• Metabolic Syndrome/metabolism
• Prevalence

• auditory verbal hallucinations
• bipolar disorder
• delusions
• psychological interventions
• psychotic symptoms

• Beck depression inventory
• bipolar
• depression
• unipolar