{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T02:39:44Z","timestamp":1772159984778,"version":"3.50.1"},"reference-count":42,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009647","name":"Ministry of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009647","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002809","name":"Generalitat de Catalunya","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Psychiatr Scand"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Psychotic symptoms are frequent during acute episodes of bipolar disorder (BD), particularly in mania, and are traditionally considered a marker of greater severity and worse prognosis. However, data comparing psychotic and nonpsychotic mania remain limited and inconsistent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to retrospectively examine clinical, therapeutical and 3\u2010year outcome differences between patients hospitalized for mania with and without psychotic symptoms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We included all patients admitted for a manic episode to the acute psychiatry unit at Hospital Cl\u00ednic of Barcelona between 2015 and 2019 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009277). Data were extracted from medical records. Patients were followed for 3\u2009years to assess psychiatric emergency department (PED) visits and readmissions. Functional outcomes were also analyzed in the BD subgroup (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009234). Descriptive statistics and survival analyses were used.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Psychotic symptoms were present in 73.6% of the patients and were associated with younger age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), earlier onset (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020), poorer insight (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), higher cannabis use (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.018) and manic predominant polarity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090006). Non\u2010psychotic patients had more previous admissions for depressive episodes (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), more previous mixed episodes (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.006) and suicide attempts (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). No significant differences were found in PED visits or readmissions in the next 3\u2009years. Logistic regression identified the number of previous mixed\u2010episode\u2010related admissions as a significant predictor of readmissions (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.041), while psychotic symptoms were not associated with either outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While psychotic and non\u2010psychotic mania show clinical and therapeutical differences, psychosis may not predict short\u2010 to medium\u2010term outcomes. Non\u2010psychotic mania\u2014which is associated with depressive polarity, mixed features and suicidal behaviour\u2014may indicate a clinically relevant and therapeutically challenging but underrecognized subgroup. These findings call for a nuanced comprehension of the impact of psychosis in mania and multidimensional approaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acps.70049","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:39:27Z","timestamp":1764549567000},"page":"122-132","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychotic or Not, Mania Hurts: A 5\u2010Year Cohort Study With a Spotlight on the Non\u2010Psychotic Subtype and Mixed Features"],"prefix":"10.1111","volume":"153","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3420-6231","authenticated-orcid":false,"given":"Helena","family":"Andreu","sequence":"first","affiliation":[{"name":"Psychiatry and Psychology Department, Institut Cl\u00ednic de Neuroci\u00e8ncies Hospital Cl\u00ednic de Barcelona  Barcelona Spain"},{"name":"Bipolar and Depressive Disorders Unit Hosp\u00ectal Clinic de Barcelona  Barcelona Spain"},{"name":"Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro) University of Barcelona (UB)  Barcelona Catalonia Spain"},{"name":"Institut D'investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS)  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Gim\u00e9nez\u2010Palomo","sequence":"additional","affiliation":[{"name":"Psychiatry and Psychology Department, Institut Cl\u00ednic de Neuroci\u00e8ncies Hospital Cl\u00ednic de Barcelona  Barcelona Spain"},{"name":"Bipolar and Depressive Disorders Unit Hosp\u00ectal Clinic de Barcelona  Barcelona Spain"},{"name":"Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro) University of Barcelona (UB)  Barcelona Catalonia Spain"},{"name":"Institut D'investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS)  Barcelona Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en red de Salud Mental (CIBERSAM) Instituto de Salud Carlos III  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5304-1338","authenticated-orcid":false,"given":"Luis","family":"Olivier","sequence":"additional","affiliation":[{"name":"Psychiatry and Psychology Department, Institut Cl\u00ednic de Neuroci\u00e8ncies Hospital Cl\u00ednic de Barcelona  Barcelona Spain"},{"name":"Bipolar and Depressive Disorders Unit Hosp\u00ectal Clinic de Barcelona  Barcelona Spain"},{"name":"Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences (UBNeuro) University of Barcelona (UB)  Barcelona Catalonia Spain"},{"name":"Institut D'investigacions Biom\u00e8diques August Pi i Sunyer (IDIBAPS)  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"I\u00f1aki","family":"Ochandiano","sequence":"additional","affiliation":[{"name":"Psychiatry and Psychology Department, Institut Cl\u00ednic de 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