The Association of Bipolar Spectrum Psychopathology with Psychotic-Like and Schizotypic Symptoms

Bipolar disorders are increasingly understood as part of a spectrum of clinical and subclinical symptoms and impairment. Upwards of 50% of patients with bipolar disorders experience psychotic symptoms as part of their mood episodes. However, studies largely have not examined the extent to which people with subclinical bipolar spectrum psychopathology experience psychotic-like or schizotypic symptoms. The present study examined the association of bipolar spectrum psychopathology (as assessed by the Hypomanic Personality Scale [HPS]) with interview ratings of psychotic-like and schizotypic experiences in a sample of 177 young adults. HPS scores were associated with positive and disorganized schizotypic symptoms, as well as with schizotypal and paranoid personality disorder traits. Contrary to hypotheses, questionnaire measures of positive, negative, and disorganized schizotypy did not moderate the associations of the HPS with measures of psychopathology and impairment. However, exploratory analyses suggested that the schizotypy subscales mediated the association of HPS scores with these outcomes. These findings indicate that subclinical expressions of bipolar spectrum psychopathology are associated with psychotic-like and schizotypic symptoms consistent with psychotic features that characterize bipolar disorders. Overall, this study supports a shared dimension of psychosis that extends through subclinical functioning both in the bipolar and schizophrenia spectrum psychopathologies.