Association between grandiose delusions in first-episode psychosis and diagnostic evolution to bipolar disorder: a two-year follow-up study

Abstract

First-Episode Psychosis (FEP) is the onset of psychotic symptoms such as delusions, hallucinations, negative symptoms, or behavioural and cognitive disturbances. FEP has a significant personal, functional, and social impact and may progress to DSM-5 diagnoses including schizophrenia, bipolar disorder, or other psychotic and affective disorders. Predicting its evolution at onset is challenging due to clinical heterogeneity, requiring longitudinal follow-up to determine an accurate diagnostic trajectory. Early identification of FEP evolution enables timely diagnosis and early appropriate treatment, improving functional prognosis and reducing risks such as higher suicide or reduced quality of life. Grandiose delusions are particularly relevant initial symptoms, present in both schizophrenia and bipolar disorder, but their prognostic value and content remain understudied. This study examines FEP patients with grandiose delusions, categorizes them into subtypes (inflated ego, fame, religiosity, attraction) using the B-MGI scale, and explores associations with diagnostic evolution toward bipolar disorder

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