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

Abstract

Background. Distinguishing prodromes of bipolar disorder (BD) specific to children/adolescents, adults, and elderly patients is essential. The primary objective of this systematic review was to determine initial and relapse prodromes identifying adult patients with BD. Methods. PubMed, PsycINFO, and Web of Science databases were searched using a predetermined strategy. A controlled process of study selection and data extraction was performed. Results. The 22 articles selected included 1,809 adult patients with BD. Initial prodromes cited most frequently in these studies showed low specificity. Among relapse prodromes cited most frequently, more talkative than usual, increased energy/more goal-directed behavior, thoughts start to race, increased self-esteem, strong interest in sex, increase in activity, and spending too much were identified exclusively before a manic/hypomanic episode, while loss of interest and hypersomnia were detected only before a depressive episode. Initial prodromal phases lasted longer than prodromal relapse phases. In the selected studies, the most used prodrome identification procedure was the clinical interview. Conclusions. For adult patients with BD, initial and relapse prodromes of manic, hypomanic, and depressive episodes were identified. It is proposed that the most frequent prodromes found in this review be incorporated into a smartphone app that monitors the functioning of people at risk of BD and patients who have already been diagnosed. Data from this app would constitute a relevant source of big data.

Risks and benefits of psilocybin use in people with bipolar disorder: An international web-based survey on experiences of ‘magic mushroom’ consumption

“…Negative or unwanted impacts of psilocybin use were most commonly new or increasing manic symptoms, sleep difficulties and anxiety. Sleep disturbances are of particular concern for people with BD, given accumulating prospective evidence demonstrating their association with the recurrence of mood episodes, particularly mania ( Cretu et al, 2016 ; Gruber et al, 2011 ; Perlman et al, 2006 ; Sylvia et al, 2011 ), but also extending to hypomania and depression ( Andrade-Gonzalez et al, 2020 ; Lam and Wong, 2005 ). In addition, anxiety is a common prodrome for both depressive and manic/hypomanic episodes in patients with BD I and II ( Andrade-Gonzalez et al, 2020 ; Lam and Wong, 2005 ).…”

“…Sleep disturbances are of particular concern for people with BD, given accumulating prospective evidence demonstrating their association with the recurrence of mood episodes, particularly mania ( Cretu et al, 2016 ; Gruber et al, 2011 ; Perlman et al, 2006 ; Sylvia et al, 2011 ), but also extending to hypomania and depression ( Andrade-Gonzalez et al, 2020 ; Lam and Wong, 2005 ). In addition, anxiety is a common prodrome for both depressive and manic/hypomanic episodes in patients with BD I and II ( Andrade-Gonzalez et al, 2020 ; Lam and Wong, 2005 ). As mentioned earlier, it may be expected that individuals with BD I are more vulnerable to adverse effects of psilocybin use; however, in the present sample people with BD I and BD II were equally as likely to report the experience of any adverse or unwanted outcome overall.…”

Prodromal phase: Differences in prodromal symptoms, risk factors and markers of vulnerability in first episode mania versus first episode psychosis with onset in late adolescence or adulthood

“…The manic prodrome was characterized by at least three subthreshold manic symptoms in more than half of the youth assessed by Correll and colleagues 6 . In a systematic review, subthreshold manic symptoms such as Overly talkative , Racing thoughts and Physical agitation were among the most frequently reported symptoms in the initial prodrome to mania in BD type I 41 . On the contrary, Reduced drive and motivation , Anergia , Depressed mood and subsyndromal Delusional ideas or Suspiciousness were among the prodromal features most commonly described in FEP studies 3,42 .…”

“… 6 In a systematic review, subthreshold manic symptoms such as Overly talkative , Racing thoughts and Physical agitation were among the most frequently reported symptoms in the initial prodrome to mania in BD type I. 41 On the contrary, Reduced drive and motivation , Anergia , Depressed mood and subsyndromal Delusional ideas or Suspiciousness were among the prodromal features most commonly described in FEP studies. 3 , 42 In the comparison between the psychotic and the manic prodromes, attenuated psychotic symptoms 12 and unusual subsyndromal ideas 11 were the symptoms more frequently associated with the prodromal phase to a FEP, whilst subsyndromal manic symptoms were more frequently associated with the manic prodrome.…”

Belief updating in bipolar disorder predicts time of recurrence

“…While mood symptoms of full-blown episode are different for depression and mania, both polarities are preceded by many of the same subsyndromal a-specific symptoms. These symptoms, known as prodromes, represent the main therapeutic target when treating recurrences ( Vieta et al, 2018 ) and include sleep disturbances, irritability, and mood instability ( Andrade-González et al, 2020 ). It is thus possible that a pessimistic view triggers these common subsyndromal symptoms.…”