Age onset of psychotic versus non-psychotic bipolar illness in men and in women

Objective: To investigate the relationship between psychotic symptoms and age at onset of bipolar illness. Method: The charts of bipolar patients treated at the Massachusetts General Hospital Bipolar Clinic were reviewed for age of first affective episode, demographics and history of psychotic symptoms. Results: Data was obtained for 328 bipolar patients (56.7% females) of whom 42% had psychotic symptoms sometime through the course of their illness. Overall, there was no significant difference in age of onset between the psychotic and non-psychotic groups. Additional analysis carried out separately by gender found significant difference for males but not for females. Age at onset for psychotic males was significantly lower than non-psychotic males. Psychosis was less common in males than females. The mean age of onset for psychotic males was significantly lower than psychotic females. Conclusion: This result implies that developmental physiology underlying psychosis in bipolar illness may differ for men and women. The different proportions of males and females in the study samples may account for conflicting results reported in the literature for age of onset of psychotic bipolar illness.