Clinical characteristics and influence of childhood trauma on the prodrome of bipolar disorder

Abstract

Objectives: To describe the onset pattern, frequency, and severity of the signs and symptoms of the prodrome of the first hypomanic/manic episode and first depressive episode of bipolar disorder (BD) and to investigate the influence of a history of childhood maltreatment on the expression of prodromal symptoms. Methods: Using a semi-structured interview, the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), information regarding prodromal symptoms was assessed from patients with a DSM-IV diagnosis of BD. History of childhood maltreatment was evaluated using the Childhood Trauma Questionnaire (CTQ). Results: Forty-three individuals with stable BD were included. On average, the prodrome of mania lasted 35.8668.7 months and was predominantly subacute or insidious, with rare acute presentations. The prodrome of depression lasted 16.6623.3 months and was also predominantly subacute or insidious, with few acute presentations. The prodromal symptoms most frequently reported prior to the first hypomanic or manic episode were mood lability, depressive mood, and impatience. A history of childhood abuse and neglect was reported by 81.4% of participants. Presence of childhood maltreatment was positively associated with prodromal symptoms, including social withdrawal, decreased functioning, and anhedonia. Conclusions: This study provides evidence of a long-lasting, symptomatic prodrome prior to first hypomanic/manic and depressive episode in BD and suggests that a history of childhood maltreatment influences the manifestations of this prodrome.

Initial and relapse prodromes in adult patients with episodes of bipolar disorder: A systematic review

“…The average length of the prodromal phase of mania/hypomania was 1.5 months in Zeschel et al [38], and 33.26 and 43.54 months for prodromes of mania and hypomania, respectively, in Noto et al [36]. Additionally, the prodromal phase of depression lasted 4.3 months in Zeschel et al [38], and 9.88 months in patients with BD I and 31.87 months in BD II, in the study by Noto et al [36]. Seven articles included data about the duration of relapse prodromes [27][28][29]31,32,34,39].…”

“…Four of the six selected articles that studied initial prodromes used semi-structured interviews to identify them [22,[36][37][38]; three of the four semi-structured interviews were developed ad hoc [22,37,38]; two of the four used the Bipolar Prodrome Symptom Scale-Retrospective [36,38]. Benti et al [22] also used a questionnaire prepared ad hoc.…”

“…The initial prodrome called mood lability/mood swings warrants particular attention. This prodrome was identified in three studies before a manic/hypomanic episode and a depressive episode [36][37][38]. Furthermore, the study by Benti et al [22] identified "up and down" moods, and the study by Estey et al [4] detected "mood changed quickly," although both studies did not distinguish whether these prodromes preceded a manic/hypomanic or depressive episode.…”

“…Patients with types I and II BD show specific characteristics and appear to have varied responses to different mood stabilizers [46]. Only one of the studies reviewed here examined the differences between both types of BD regarding initial prodromes [36] and one regarding relapse prodromes [28]; thus, it was not possible to obtain more evidence related to the specificity of these prodromes in each type of BD.…”

Challenges and developments in research of the early stages of bipolar disorder

“…[30][31][32] On the other hand, in clinical practice, identification of a symptomatic high-risk BD phase is complicated by the complex nature of dimensions of this disorder, by potentially different symptom presentations in children and adolescents, 5,21,33 and by the blurred lines between the prodrome and the disease itself. 34 Retrospective and prospective studies have revealed a pattern of putative prodromal symptoms, of which mood lability/mood swings/cyclothymic features, depressive mood, racing thoughts, irritability, and physical agitation are most commonly reported. 4,21 Considering that the onset of first manic episode occurs mainly in adolescence and early adulthood, it can be assumed that mild, poorly differentiated, or nonspecific symptoms influence the earliest developmental stages of the individual.…”