Patients with bipolar disorder with psychotic symptoms with a longer duration of untreated illness are worse off than patients diagnosed with the condition earlier, a retrospective study shows.

The duration of untreated psychosis (DUP), duration of untreated illness (DUI), and initial diagnosis of 240 bipolar disorder (BD) patients with psychotic symptoms were extrapolated through a retrospective review of clinical charts, Lombardy database, and, if necessary, through clinical interviews with patients and their relatives. DUP was defined as the time between the onset of psychotic symptoms and the start of antipsychotic treatment, while DUI was defined as the time between the onset of any symptoms of BD and the start of the appropriate mood-stabilizing therapy.

Most (61.5%) of the study’s participants initially were diagnosed with illnesses other than bipolar disorder with psychotic symptoms; the top most common misdiagnosis was delusional disorder.

For patients with DUIs of less than or equal to 8 years, Global Assessment of Functioning (GAF) scores were significantly higher than for patients with DUIs of greater than 8 years. Another significant difference that was found between these two groups was in the number of hospitalizations; participants in the group with longer DUIs faced significantly more of these.

The results of the study suggest that DUI, but not DUP, “seem to affect [at least partly] long-term prognosis” in patients with [bipolar disorder] with psychotic symptoms, according to Dr. A. Carlo Altamura and his colleagues.

Among the study’s conclusions is that “early-onset [bipolar disorder] patients with psychotic features have a long-term poorer working functioning” than late-onset BD patients with psychotic symptoms, according to the researchers.

Read the full study in the Journal of Affective Disorders ( doi:10.1016/j.jd2015.04.024 ).