Course of illness in psychotic mania: is mood incongruence important?

Previous research is inconsistent regarding the significance of mood-incongruent psychotic symptoms in relation to the severity and course of bipolar disorder. In the present study, bipolar I patients were assessed at index hospitalization using standardized symptom measures and followed up to 28 months. We contrasted the symptomatic course in patients experiencing mood-congruent versus mood-incongruent psychotic symptoms. Results revealed that patients spent an average of 29% of the time during follow-up in a mood episode, but only 5% of the time with psychotic symptoms. Few differences were found at the index hospitalization and no differences were found on any longitudinal course variables between mood-congruence subtypes. Although experiencing high levels of psychosis at baseline, both subtypes improved considerably following hospitalization, and psychotic symptom levels remained relatively stable. Current results suggest that when provided efficacious treatment, mood-incongruent psychotic mania does not predict a worse symptomatic course of illness.