Hostname: page-component-5d84bcc8dc-hqq7n Total loading time: 0 Render date: 2026-09-14T20:47:20.322Z Has data issue: false hasContentIssue false
  • English
  • Français

The co-occurrence of manic and depressive dimensions in early psychosis: a latent transition analysis

Published online by Cambridge University Press:  19 May 2023

Julie Ramain Open the ORCID record for Julie Ramain [Opens in a new window] ,
Lilith Abrahamyan Empson ,
Luis Alameda ,
Alessandra Solida ,
Julien Elowe ,
Nadir Mebdouhi ,
Philippe Conus  and
Philippe Golay
Julie Ramain*
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland Training and Research Institute in Mental Health (IFRSM), Neuchâtel Centre of Psychiatry, Neuchâtel, Switzerland
Lilith Abrahamyan Empson
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
Luis Alameda
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, UK Departamento de Psiquiatria, Centro Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Sevilla, Spain
Alessandra Solida
Affiliation:
Department II of Adult Psychiatry, Neuchâtel Center of Psychiatry, Neuchâtel, Switzerland
Julien Elowe
Affiliation:
Service of Adult Psychiatry North-West, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Prangins, Switzerland
Nadir Mebdouhi
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
Philippe Conus
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
Philippe Golay
Affiliation:
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland Faculty of Social and Political Sciences, Institute of Psychology, University of Lausanne, Lausanne, Switzerland
*
Corresponding author: Julie Ramain; Email: julie.ramain@cnp.ch
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Frequently associated with early psychosis, depressive and manic dimensions may play an important role in its course and outcome. While manic and depressive symptoms can alternate and co-occur, most of the studies in early intervention investigated these symptoms independently. The aim of this study was therefore to explore the co-occurrence of manic and depressive dimensions, their evolution and impact on outcomes.

Methods

We prospectively studied first-episode psychosis patients (N = 313) within an early intervention program over 3 years. Based on latent transition analysis, we identified sub-groups of patients with different mood profiles considering both manic and depressive dimensions, and studied their outcomes.

Results

Our results revealed six different mood profiles at program entry and after 1.5 years follow-up (absence of mood disturbance, co-occurrence, mild depressive, severe depressive, manic and hypomanic), and four after 3 years (absence of mood disturbance, co-occurrence, mild depressive and hypomanic). Patients with absence of mood disturbance at discharge had better outcomes. All patients with co-occurring symptoms at program entry remained symptomatic at discharge. Patients with mild depressive symptoms were less likely to return to premorbid functional level at discharge than the other subgroups. Patients displaying a depressive component had poorer quality of physical and psychological health at discharge.

Conclusions

Our results confirm the major role played by mood dimensions in early psychosis, and show that profiles with co-occurring manic and depressive dimensions are at risk of poorer outcome. An accurate assessment and treatment of these dimensions in people with early psychosis is crucial.

Keywords

Depressionearly interventionfirst-episode psychosismaniamood

Information

Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 16 , December 2023 , pp. 7601 - 7608
Check for updates
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Alameda, L., Conus, P., Ramain, J., Solida, A., & Golay, P. (2022). Evidence of mediation of severity of anxiety and depressive symptoms between abuse and positive symptoms of psychosis. Journal of Psychiatric Research, 150, 353–359. doi: 10.1016/j.jpsychires.2021.11.027CrossRefGoogle ScholarPubMed
Alameda, L., Golay, P., Baumann, P. S., Progin, P., Mebdouhi, N., Elowe, J., … Conus, P. (2017). Mild depressive symptoms mediate the impact of childhood trauma on long-term functional outcome in early psychosis patients. Schizophrenia Bulletin, 43(5), 1027–1035. doi: 10.1093/schbul/sbw163CrossRefGoogle ScholarPubMed
Alameda, L., Rodriguez, V., Carr, E., Aas, M., Trotta, G., Marino, P., … Spinazzola, E. (2020). A systematic review on mediators between adversity and psychosis: Potential targets for treatment. Psychological Medicine, 50(12), 1966–1976.CrossRefGoogle ScholarPubMed
Andreasen, N. C., Carpenter, W. T. Jr., Kane, J. M., Lasser, R. A., Marder, S. R., & Weinberger, D. R. (2005). Remission in schizophrenia: Proposed criteria and rationale for consensus. American Journal of Psychiatry, 162(3), 441–449. doi: 10.1176/appi.ajp.162.3.441CrossRefGoogle ScholarPubMed
Arrasate, M., Gonzalez-Ortega, I., Alberich, S., Gutierrez, M., Martinez-Cengotitabengoa, M., Mosquera, F., … Gonzalez-Pinto, A. (2014). Affective dimensions as a diagnostic tool for bipolar disorder in first psychotic episodes. European Psychiatry, 29(7), 424–430. doi: 10.1016/j.eurpsy.2013.07.005CrossRefGoogle ScholarPubMed
Bauer, M. S., Simon, G. E., Ludman, E., & Unützer, J. (2005). ‘Bipolarity’ in bipolar disorder: Distribution of manic and depressive symptoms in a treated population. British Journal of Psychiatry, 187(1), 87–88. doi: 10.1192/bjp.187.1.87CrossRefGoogle Scholar
Baumann, P. S., Crespi, S., Marion-Veyron, R., Solida, A., Thonney, J., Favrod, J., … Conus, P. (2013). Treatment and early intervention in psychosis program (TIPP-Lausanne): Implementation of an early intervention programme for psychosis in Switzerland. Early Intervention in Psychiatry, 7(3), 322–328. doi: 10.1111/eip.12037CrossRefGoogle ScholarPubMed
Bebbington, P. (2015). Unravelling psychosis: Psychosocial epidemiology, mechanism, and meaning. Shanghai Archives of Psychiatry, 27(2), 70–81. doi: 10.11919/j.issn.1002-0829.215027Google ScholarPubMed
Berk, M. (2007). Early intervention in bipolar disorders: Opportunities and pitfalls. Acta Neuropsychiatrica, 19(1), 68–69.CrossRefGoogle Scholar
Birchwood, M., Todd, P., & Jackson, C. (1998). Early intervention in psychosis. The critical period hypothesis. British Journal of Psychiatry Supplement, 172(33), 53–59.CrossRefGoogle ScholarPubMed
Calderon-Mediavilla, M., Vila-Badia, R., Dolz, M., Butjosa, A., Barajas, A., Del Cacho, N., … Ochoa, S. (2021). Depressive symptoms and their relationship with negative and other psychotic symptoms in early onset psychosis. European Child & Adolescent Psychiatry, 30(9), 1383–1390. doi: 10.1007/s00787-020-01618-0CrossRefGoogle ScholarPubMed
Ciompi, L. (2015). The key role of emotions in the schizophrenia puzzle. Schizophrenia Bulletin, 41(2), 318–322. doi: 10.1093/schbul/sbu158CrossRefGoogle ScholarPubMed
Coentre, R., Talina, M. C., Góis, C., & Figueira, M. L. (2017). Depressive symptoms and suicidal behavior after first-episode psychosis: A comprehensive systematic review. Psychiatry Research, 253, 240–248. doi: 10.1016/j.psychres.2017.04.010CrossRefGoogle ScholarPubMed
Conus, P., & Bonsack, C. (2004). [Early intervention for the initial phase of psychotic disorders in Lausanne: What problems and what solutions?]. Revue Medicale Suisse Romande, 124(4), 221–224.Google ScholarPubMed
Conus, P., Cotton, S., Abdel-Baki, A., Lambert, M., Berk, M., & McGorry, P. D. (2006). Symptomatic and functional outcome 12 months after a first episode of psychotic mania: Barriers to recovery in a catchment area sample. Bipolar Disorder, 8(3), 221–231. doi: 10.1111/j.1399-5618.2006.00315.xCrossRefGoogle Scholar
Conus, P., & McGorry, P. D. (2002). First-episode mania: A neglected priority for early intervention. Australian & New Zealand Journal of Psychiatry, 36(2), 158–172. doi: 10.1046/j.1440-1614.2002.00994.xCrossRefGoogle Scholar
Correll, C. U., Galling, B., Pawar, A., Krivko, A., Bonetto, C., Ruggeri, M., … Kane, J. M. (2018). Comparison of early intervention services vs treatment as usual for early-phase psychosis: A systematic review, meta-analysis, and meta-regression. JAMA Psychiatry, 75(6), 555–565. doi: 10.1001/jamapsychiatry.2018.0623CrossRefGoogle ScholarPubMed
Dempster, K., Li, A., Sabesan, P., Norman, R., & Palaniyappan, L. (2021). Treatment resistance: A time-based approach for early identification in first episode psychosis. Journal of Personalized Medicine, 11(8), 711. doi: 10.3390/jpm11080711CrossRefGoogle ScholarPubMed
Fiedorowicz, J. G., Persons, J. E., Assari, S., Ostacher, M. J., Goes, F. S., Nurnberger, J. I., & Coryell, W. H. (2021). Moderators of the association between depressive, manic, and mixed mood symptoms and suicidal ideation and behavior: An analysis of the national network of depression centers mood outcomes program. Journal of Affective Disorders, 281, 623–630. doi: 10.1016/j.jad.2020.11.101CrossRefGoogle ScholarPubMed
Fusar-Poli, P., McGorry, P. D., & Kane, J. M. (2017). Improving outcomes of first-episode psychosis: An overview. World Psychiatry, 16(3), 251–265. doi: 10.1002/wps.20446CrossRefGoogle ScholarPubMed
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., … Tran, N. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian & New Zealand Journal of Psychiatry, 50(5), 410–472. doi: 10.1177/0004867416641195CrossRefGoogle ScholarPubMed
Golay, P., Laloyaux, J., Moga, M., Della Libera, C., Larøi, F., & Bonsack, C. (2020). Psychometric investigation of the French version of the Aberrant Salience Inventory (ASI): Differentiating patients with psychosis, patients with other psychiatric diagnoses and non-clinical participants. Annals of General Psychiatry, 19(1), 1–10.CrossRefGoogle ScholarPubMed
Golay, P., Morandi, S., Silva, B., Devas, C., & Bonsack, C. (2019). Feeling coerced during psychiatric hospitalization: Impact of perceived status of admission and perceived usefulness of hospitalization. International Journal of Law and Psychiatry, 67, 101512. doi: 10.1016/j.ijlp.2019.101512CrossRefGoogle ScholarPubMed
Jeffreys, H. (1961). Theory of probability (3rd ed.). Oxford: Clarendon.Google Scholar
Kass, R. E., & Raftery, A. E. (1995). Bayes factors. Journal of the American Statistical Association, 90(430), 773–795.CrossRefGoogle Scholar
Kennedy, N., Everitt, B., Boydell, J., Van Os, J., Jones, P. B., & Murray, R. M. (2005). Incidence and distribution of first-episode mania by age: Results from a 35-year study. Psychological Medicine, 35(6), 855–863. doi: 10.1017/S0033291704003307CrossRefGoogle ScholarPubMed
Lambert, M., Conus, P., Lambert, T., & McGorry, P. D. (2003). Pharmacotherapy of first-episode psychosis. Expert Opinion on Pharmacotherapy, 4(5), 717–750. doi: 10.1517/14656566.4.5.717CrossRefGoogle ScholarPubMed
Marneros, A., Röttig, S., Wenzel, A., Blöink, R., & Brieger, P. (2004). Affective and schizoaffective mixed states. European Archives of Psychiatry and Clinical Neuroscience, 254(2), 76–81. doi: 10.1007/s00406-004-0462-9CrossRefGoogle ScholarPubMed
Marwaha, S., Hett, D., Johnson, S., Fowler, D., Hodgekins, J., Freemantle, N., … Birchwood, M. (2021). The impact of manic symptoms in first-episode psychosis: Findings from the UK National EDEN study. Acta Psychiatrica Scandinavica, 144(4), 358–367. doi: 10.1111/acps.13307CrossRefGoogle ScholarPubMed
McGinty, J., & Upthegrove, R. (2020). Depressive symptoms during first episode psychosis and functional outcome: A systematic review and meta-analysis. Schizophrenia Research, 218, 14–27. doi: 10.1016/j.schres.2019.12.011CrossRefGoogle ScholarPubMed
Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389. doi: 10.1192/bjp.134.4.382CrossRefGoogle ScholarPubMed
Morrissette, D. A., & Stahl, S. M. (2011). Affective symptoms in schizophrenia. Drug Discovery Today: Therapeutic Strategies, 8(1), 3–9. doi: 10.1016/j.ddstr.2011.10.005.Google Scholar
Noël, Y. (2013). AtelieR: A GTK GUI for teaching basic concepts in statistical inference, and doing elementary bayesian tests. R package version 0.24. Retrieved from https://CRAN.R-project.org/package=AtelieR.Google Scholar
Noël, Y. (2015). Psychologie statistique avec R. Les Ulis: EDP Sciences. https://doi.org/10.1051/978-2-7598-1756-6.Google Scholar
Noël, Y. (2018). R2STATS Group models. Retrieved from http://yvonnick.noel.free.fr/r2statsweb/bayes.html.Google Scholar
Ramain, J., Conus, P., & Golay, P. (2021a). A narrative review of intervention in first-episode affective psychoses. Journal of Psychiatric Research, 143, 123–137. doi: 10.1016/j.jpsychires.2021.09.023CrossRefGoogle ScholarPubMed
Ramain, J., Conus, P., & Golay, P. (2021b). Subtyping based on premorbid profile: A strategy to personalize treatment in first-episode affective psychosis. Early Intervention in Psychiatry, 16(1), 51–60. doi: 10.1111/eip.13130.CrossRefGoogle ScholarPubMed
Ramain, J., Conus, P., & Golay, P. (2022). Exploring the clinical relevance of a dichotomy between affective and non-affective psychosis: Results from a first-episode psychosis cohort study. Early Intervention in Psychiatry, 16(2), 168–177. doi: 10.1111/eip.13143CrossRefGoogle ScholarPubMed
Ratheesh, A., Davey, C. G., Daglas, R., Macneil, C., Hasty, M., Filia, K., … Cotton, S. (2017). Social and academic premorbid adjustment domains predict different functional outcomes among youth with first episode mania. Journal of Affective Disorders, 219, 133–140. doi: 10.1016/j.jad.2017.05.030CrossRefGoogle ScholarPubMed
Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6(2), 461–464.CrossRefGoogle Scholar
Strakowski, S. M., Keck, P. E. Jr., McElroy, S. L., West, S. A., Sax, K. W., Hawkins, J. M., … Bourne, M. L. (1998). Twelve-month outcome after a first hospitalization for affective psychosis. Archives of General Psychiatry, 55(1), 49–55. doi: 10.1001/archpsyc.55.1.49CrossRefGoogle ScholarPubMed
The World Health Organization (1995). The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Social Science & Medicine, 41(10), 1403–1409.CrossRefGoogle Scholar
Tohen, M., Hennen, J., Zarate, C. M. Jr., Baldessarini, R. J., Strakowski, S. M., Stoll, A. L., … Cohen, B. M. (2000). Two-year syndromal and functional recovery in 219 cases of first-episode major affective disorder with psychotic features. American Journal of Psychiatry, 157(2), 220–228. doi: 10.1176/appi.ajp.157.2.220CrossRefGoogle ScholarPubMed
van Os, J., Pries, L. K., Ten Have, M., de Graaf, R., van Dorsselaer, S., Delespaul, P., … Guloksuz, S. (2020). Evidence, and replication thereof, that molecular-genetic and environmental risks for psychosis impact through an affective pathway. Psychological Medicine, 52(10), 1910–1922. doi: 10.1017/s0033291720003748.CrossRefGoogle ScholarPubMed
Wagenmakers, E. J., Wetzels, R., Borsboom, D., & Van Der Maas, H. L. (2011). Why psychologists must change the way they analyze their data: The case of psi: Comment on Bem (2011). Journal of Personality and Social Psychology, 100(3), 426–432.CrossRefGoogle ScholarPubMed
Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: Reliability, validity and sensitivity. British Journal of Psychiatry, 133, 429–435.CrossRefGoogle ScholarPubMed
Yung, A. R., Yuen, H. P., McGorry, P. D., Phillips, L. J., Kelly, D., Dell'Olio, M., … Buckby, J. (2005). Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states. Australian & New Zealand Journal of Psychiatry, 39(11–12), 964–971. doi: 10.1080/j.1440-1614.2005.01714.xCrossRefGoogle ScholarPubMed