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Psychiatry1 paper

Severe bipolar disorder with psychotic features

Last edited: 4/10/2026

Overview

Severe bipolar disorder (BD) is a mental health condition characterized by significant mood swings, including manic and depressive episodes. When accompanied by psychotic features, individuals may experience hallucinations or delusions, further impairing their ability to function 1.

Diagnosis

  • Cognitive deficits are a core feature of BD that persist during euthymic phases and affect global functioning 1.
  • No consensus exists on the optimal tool to capture cognitive deficits in BD, though various instruments show acceptable-to-good psychometric properties 1.
  • Brief cognitive screeners and comprehensive batteries may be appropriate for detecting or monitoring cognitive changes 1.
  • Further research is needed to investigate cognitive tools that assess affective and social cognition 1.
  • Management

  • Adherence to prescribed medication regimens improves outcomes for patients with severe mental illness, including bipolar disorder 2.
  • Interventions to improve medication adherence include educational, behavioral, family-based, technological, or combined approaches 2.
  • No significant differences were found in adherence among different types of interventions when considered separately by subgroups 2.
  • Key Recommendations

  • Various neuropsychological instruments are available for assessing cognitive deficits in bipolar disorder, with acceptable-to-good psychometric properties 1. (Evidence: Moderate)
  • Interventions such as educational, behavioral, family-based, and technological approaches can be used to improve medication adherence in patients with bipolar disorder 2. (Evidence: Moderate)
  • Web-based instruments are expected to become a primary choice for cognitive screening in bipolar disorder 1. (Evidence: Expert opinion)
  • References

    1 Rossetti MG, Girelli F, Perlini C, Brambilla P, Bellani M. Neuropsychological instruments for bipolar disorders: A systematic review on psychometric properties. Journal of affective disorders 2023. link 2 Loots E, Goossens E, Vanwesemael T, Morrens M, Van Rompaey B, Dilles T. Interventions to Improve Medication Adherence in Patients with Schizophrenia or Bipolar Disorders: A Systematic Review and Meta-Analysis. International journal of environmental research and public health 2021. link

    Original source

    1. [1]
      Neuropsychological instruments for bipolar disorders: A systematic review on psychometric properties.Rossetti MG, Girelli F, Perlini C, Brambilla P, Bellani M Journal of affective disorders (2023)
    2. [2]
      Interventions to Improve Medication Adherence in Patients with Schizophrenia or Bipolar Disorders: A Systematic Review and Meta-Analysis.Loots E, Goossens E, Vanwesemael T, Morrens M, Van Rompaey B, Dilles T International journal of environmental research and public health (2021)

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