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Comparison of psychotic bipolar disorder, schizoaffective disorder, and schizophrenia: an international, multisite study
Author(s) -
Tondo L.,
Vázquez G. H.,
Baethge C.,
Baronessa C.,
Bolzani L.,
Koukopoulos A.,
Mazzarini L.,
Murru A.,
Pacchiarotti I.,
Pinna M.,
Salvatore P.,
Sani G.,
Selle V.,
Spalletta G.,
Girardi P.,
Tohen M.,
Vieta E.,
Baldessarini R. J.
Publication year - 2016
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.12447
Subject(s) - bipolar disorder , schizoaffective disorder , schizophrenia (object oriented programming) , psychology , psychosis , research diagnostic criteria , psychiatry , medical diagnosis , clinical psychology , medicine , cognition , pathology
Objective Nosological distinctions among schizoaffective disorder ( SA ), bipolar I disorder with psychotic features ( BD p), and schizophrenia ( SZ ) remain unresolved. Method We compared 2269 subjects with psychotic features in DSM ‐ IV ‐ TR diagnoses (1435 BD p, 463 SZ , 371 SA ) from 8 collaborating international sites, by 12 sociodemographic and clinical measures, all between diagnostic pairs. Results In bivariate comparisons, SA was consistently intermediate between BD p and SZ for 11/12 features (except onset stressors), and SZ vs. BD p differed in all 12 factors. SA differed from both BD p and SZ in 9/12 factors: SA and BD p were similar in education and suicidal ideation or acts; SA and SZ were similar in education, onset stressors, and substance abuse. Meta‐analytic comparisons of diagnostic pairs for 10 categorical factors indicated similar differences of SA from both SZ and BD p. Multivariate modeling indicated significantly independent differences between BD p and SZ (8 factors), SA vs. SZ (5), and BD p vs. SA (3). Measurement variance was similar for all diagnoses. Conclusion SA was consistently intermediate between BD p and SZ . The three diagnostic groups ranked: BD p > SA > SZ related to lesser morbidity or disability. The findings are not consistent with a dyadic Kraepelinian categorization, although the considerable overlap among the three DSM ‐ IV diagnostic groups indicates uncertain boundaries if they represent distinct disorders.