Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode. (5th March 2014)

• Record Type: Journal Article
• Authors: Correll, Christoph U; Hauser, Marta; Penzner, Julie B; Auther, Andrea M; Kafantaris, Vivian; Saito, Ema; Olvet, Doreen; Carrión, Ricardo E; Birmaher, Boris; Chang, Kiki D; DelBello, Melissa P; Singh, Manpreet K; Pavuluri, Mani; Cornblatt, Barbara A
• Is Part Of: Bipolar disorders. Volume 16:Number 5(2014)
• Page Start: 478
• Page End: 492
• Publication Date: 2014-03-05
• Subjects: Manic-depressive illness -- Periodicals; Depression, Mental -- Periodicals; 616.895
• DOI: 10.1111/bdi.12194
• Languages: English
• ISSNs: 1398-5647

Abstract

<abstract abstract-type="main" id="bdi12194-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bdi12194-sec-0001" sec-type="section"> <title>Objectives</title> <p>The aim of the present study was to systematically evaluate the prodrome to mania in youth.</p> </sec> <sec id="bdi12194-sec-0002" sec-type="section"> <title>Methods</title> <p>New‐onset/worsening symptoms/signs of ≥ moderate severity preceding first mania were systematically assessed in 52 youth (16.2 ± 2.8 years) with a research diagnosis of bipolar I disorder (BD‐I). Youth and/or caregivers underwent semi‐structured interviews, using the Bipolar Prodrome Symptom Scale–Retrospective.</p> </sec> <sec id="bdi12194-sec-0003" sec-type="section"> <title>Results</title> <p>The mania prodrome was reported to start gradually in most youth (88.5%), with either <italic>slow</italic> (59.6%) or <italic>rapid</italic> (28.8%) deterioration, while a <italic>rapid‐onset‐and‐deterioration</italic> prodrome was rare (11.5%). The manic prodrome, conservatively defined as requiring ≥ 3 symptoms, lasted 10.3 ± 14.4 months [95% confidence interval (CI): 6.3–14.4], being present for ≥ 4 months in 65.4% of subjects. Among prodromal symptoms reported in ≥ 50% of youth, three were subthreshold manic in nature (irritability: 61.5%, racing thoughts: 59.6%, increased energy/activity: 50.0%), two were nonspecific (decreased school/work functioning: 65.4%, mood swings/lability: 57.7%), and one each was depressive (depressed mood: 53.8%) or subthreshold manic/depressive (inattention: 51.9%). A decreasing number of youth had ≥ 1 (84.6%), ≥ 2 (48.1%), or ≥ 3 (26.9%) '<italic>specific</italic>' subthreshold mania symptoms (i.e., elation, grandiosity, decreased need for sleep, racing thoughts, or hypersexuality), lasting 9.5 ± 14.9 months (95% CI: 5.0–14.0), 3.5 ± 3.5 months (95% CI: 2.0–4.9), and 3.0 ± 3.2 months (95% CI: 1.0–5.0) for ≥ 1, ≥ 2, or ≥ 3 specific symptoms, respectively.</p> </sec> <sec id="bdi12194-sec-0004" sec-type="section"> <title>Conclusions</title> <p>In youth with BD‐I, a relatively long, predominantly slow‐onset mania prodrome appears to be common, including subthreshold manic and depressive psychopathology symptoms. This suggests that early clinical identification and intervention may be feasible in bipolar disorder. Identifying biological markers associated with clinical symptoms of impending mania may help to increase chances for early detection and prevention before full mania.</p> </sec> </abstract>