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Subclinical psychotic experiences and bipolar spectrum features in depression: association with outcome of psychotherapy

Published online by Cambridge University Press:  07 May 2013

J. T. W. Wigman ,
J. van Os ,
L. Abidi ,
M. J. H. Huibers ,
J. Roelofs ,
A. Arntz ,
I. Kelleher  and
F. P. M. L. Peeters
J. T. W. Wigman*
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
J. van Os
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
L. Abidi
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
M. J. H. Huibers
Affiliation:
Department of Clinical Psychological Science, Research Institute of Experimental Psychopathology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
J. Roelofs
Affiliation:
Department of Clinical Psychological Science, Research Institute of Experimental Psychopathology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
A. Arntz
Affiliation:
Department of Clinical Psychological Science, Research Institute of Experimental Psychopathology, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands
I. Kelleher
Affiliation:
Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Republic of Ireland
F. P. M. L. Peeters
Affiliation:
Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
*
*Address for correspondence: J. T. W. Wigman, Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, PO Box 616 (DRT 10), 6200 MD Maastricht, The Netherlands. (Email: hanneke.wigman@maastrichtuniversity.nl)
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Abstract

Background

Subthreshold psychotic and bipolar experiences are common in major depressive disorder (MDD). However, it is unknown if effectiveness of psychotherapy is altered in depressed patients who display such features compared with those without. The current paper aimed to investigate the impact of the co-presence of subclinical psychotic experiences and subclinical bipolar symptoms on the effectiveness of psychological treatment, alone or in combination with pharmacotherapy.

Method

In a naturalistic study, patients with MDD (n = 116) received psychological treatment (cognitive behavioural therapy or interpersonal psychotherapy) alone or in combination with pharmacotherapy. Depression and functioning were assessed six times over 2 years. Lifetime psychotic experiences and bipolar symptoms were assessed at the second time point.

Results

Subclinical psychotic experiences predicted more depression over time (β = 0.20, p < 0.002), non-remission [odds ratio (OR) 7.51, p < 0.016] and relapse (OR 3.85, p < 0.034). Subthreshold bipolar symptoms predicted relapse (OR 1.16, p < 0.037).

Conclusions

In general, subclinical psychotic experiences have a negative impact on the course and outcome of psychotherapy in MDD. Effects of subclinical bipolar experiences were less prominent.

Keywords

Bipolar symptomscognitive behavioural therapyinterpersonal psychotherapymajor depressive disorderpsychotic experiencestreatment outcome
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 2 , January 2014 , pp. 325 - 336
Copyright
Copyright © Cambridge University Press 2013 

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