Features preceding diagnosis of bipolar versus major depressive disorders

Serra, Giulia; Koukopoulos, Athanasios; Chiara, Lavinia De; Napoletano, Flavia; Koukopoulos, Alexia E.; Curto, Martina; Manfredi, Giovanni; Faedda, Gianni L.; Girardi, Paolo; Baldessarini, Ross J.

doi:10.1016/j.jad.2014.10.050

Cited by 38 publications

(38 citation statements)

References 44 publications

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“…Longitudinal, including high risk family studies, are consistent with retrospective studies in identifying that sub-syndromal depressive and hypomanic symptoms often precede bipolar disorder by several years [33,43] with a reported latency between initial affective symptoms and the first identified major affective episode in BD between 8 to 12 years [34], with another 8 to 10 years from the first affective episode to the initiation of an appropriate mood-stabilizing treatment [14][15][16]. An important clinical and prognostic aspect of undiagnosed and untreated early BD is an elevated risk of substance misuse, anxiety disorders as well as conduct and antisocial disorders, with high levels of morbidity, disability and suicide [12,44].…”

Section: Long-term Outcome: Mania Versus Smd/dmddsupporting

confidence: 67%

“…Accordingly, retrospective studies found that irritability, mood lability and impulse dyscontrol may be the predominant psychopathological features of pediatric bipolar disorder at onset [33,34]. A possible explanation of this finding might be that irritability is generally a highly prevalent psychopathological feature during pediatric age.…”

Section: Discussion Clinical Symptoms: Irritability Versus Elationmentioning

confidence: 99%

“…Findings from retrospective studies of adult bipolar disorder patients indicate that between one-third to more than half had experienced early psychopathological symptoms during childhood or adolescence [16,34,40]. Perlis et al reported that 65% of a large (N=983) sample of bipolar adults reported mood symptoms starting in the prepubertal (28%) or adolescent years (37%) [41].…”

Section: Long-term Outcome: Mania Versus Smd/dmddmentioning

confidence: 99%

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Pediatric Mania: The Controversy Between Euphoria and Irritability

et al. 2017

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Pediatric Bipolar Disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders and associated with high levels of morbidity and disability and with a great risk of suicide. While there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified. We reviewed the available studies on the phenomenology of pediatric mania with the aim of summarizing the prevalence, demographics, clinical correlates and course of these two types of pediatric mania. Eighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95-100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common.Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age. Future research should focus on the heterogeneity of irritability aiming at differentiating distinct subtypes of pediatric psychiatric disorders with distinct phenomenology, course, outcome and biomarkers. Longitudinal studies of samples attending to mood presentation, irritable versus elated, and course, chronic versus episodic, may help clarify whether these are meaningful distinctions in the course, treatment and outcome of pediatric onset bipolar disorder.

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Section: Long-term Outcome: Mania Versus Smd/dmddsupporting

confidence: 67%

Section: Discussion Clinical Symptoms: Irritability Versus Elationmentioning

confidence: 99%

Section: Long-term Outcome: Mania Versus Smd/dmddmentioning

confidence: 99%

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Pediatric Mania: The Controversy Between Euphoria and Irritability

et al. 2017

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“…Accordingly, retrospective studies found that irritability, mood lability  and impulse dyscontrol may be the predominant psycho- pathological features of pediatric bipolar disorder at onset [33, 34]. A possible explanation of this finding might be that irritability is generally a highly prevalent psychopathological feature during pediatric age.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pediatric Mania: The Controversy between Euphoria and Irritability

Serra

Uchida

Battaglia

et al. 2017

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Pediatric Bipolar Disorder (BD) is a highly morbid pediatric psychiatric disease, consistently associated with family psychiatric history of mood disorders and associated with high levels of morbidity and disability and with a great risk of suicide. While there is a general consensus on the symptomatology of depression in childhood, the phenomenology of pediatric mania is still highly debated and the course and long-term outcome of pediatric BD still need to be clarified. We reviewed the available studies on the phenomenology of pediatric mania with the aim of summarizing the prevalence, demographics, clinical correlates and course of these two types of pediatric mania. Eighteen studies reported the number of subjects presenting with either irritable or elated mood during mania. Irritability has been reported to be the most frequent clinical feature of pediatric mania reaching a sensitivity of 95–100% in several samples. Only half the studies reviewed reported on number of episodes or cycling patterns and the described course was mostly chronic and ultra-rapid whereas the classical episodic presentation was less common.Few long-term outcome studies have reported a diagnostic stability of mania from childhood to young adult age. Future research should focus on the heterogeneity of irritability aiming at differentiating distinct subtypes of pediatric psychiatric disorders with distinct phenomenology, course, outcome and biomarkers. Longitudinal studies of samples attending to mood presentation, irritable versus elated, and course, chronic versus episodic, may help clarify whether these are meaningful distinctions in the course, treatment and outcome of pediatric onset bipolar disorder.

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The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management

et al. 2022

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Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multiomic" measures, electronic health records), analyzed using ad vanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at pointofcare is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features -especially during depressive episodes -and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentallyoriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, provid ing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at pointofcare.

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Features preceding diagnosis of bipolar versus major depressive disorders

Cited by 38 publications

References 44 publications

Pediatric Mania: The Controversy Between Euphoria and Irritability

Pediatric Mania: The Controversy Between Euphoria and Irritability

Pediatric Mania: The Controversy between Euphoria and Irritability

The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management

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