Temperament and prodromal symptoms prior to first manic/hypomanic episodes: Results from a pilot study

Zeschel, Eike; Bingmann, Tiffany; Bechdolf, Andreas; Krüger-Oezguerdal, Seza; Correll, Christoph U.; Leopold, Karolina; Pfennig, Andrea; Bauer, Michael; Juckel, Georg

doi:10.1016/j.jad.2014.10.031

Cited by 21 publications

(10 citation statements)

References 44 publications

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“…Based on previous work indicating that mood lability predicts the development of subthreshold manic symptoms (40) and hypomania (41), we hypothesized that baseline Child-Reported Affective Lability would contribute to increased Manic Rating Scale at the proximal visit. The model was consistent with our hypothesis: all paths tested were highly significant (most p<.001) and the root mean square error of approximation was 0.000, indicating excellent fit.…”

Section: Resultsmentioning

confidence: 99%

Toward the Definition of a Bipolar Prodrome: Dimensional Predictors of Bipolar Spectrum Disorders in At-Risk Youths

Hafeman¹,

Merranko²,

Axelson³

et al. 2016

AJP

173

199

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Objective We aimed to assess dimensional symptomatic predictors of new-onset bipolar spectrum disorder in youth at familial risk of bipolar disorder (“at-risk” youth). Method Offspring aged 6–18 of parents with bipolar-I/II disorder (n=391) and offspring of community controls (n=248) were recruited without regard to non-bipolar psychopathology. At baseline, 8.4% (33/391) of offspring of bipolar parents had bipolar spectrum; 14.7% (44/299) of offspring with follow-up developed new-onset bipolar spectrum (15 with bipolar-I/II) over eight years. Scales collected at baseline and follow-up were reduced using factor analyses; factors (both at baseline and visit proximal to conversion or last contact) were then assessed as predictors of new-onset bipolar spectrum. Results Relative to community control offspring, at-risk and bipolar offspring had higher baseline levels of anxiety/depression, inattention/disinhibition, externalizing, subsydromal manic, and affective lability symptoms (p<.05). The strongest predictors of new-onset bipolar spectrum were: baseline anxiety/depression, baseline and proximal affective lability, and proximal subsyndromal manic symptoms (p<.05). While affective lability and anxiety/depression were elevated throughout follow-up in those who later developed bipolar spectrum, manic symptoms increased up to the point of conversion. A path analysis supported the hypothesized model that affective lability at baseline predicted new-onset bipolar spectrum, in part, through increased manic symptoms at the visit prior to conversion; earlier parental age of mood disorder onset also significantly increased risk of conversion (p<.001). While youth without anxiety/depression, affective lability, and mania (and with a parent with older age of mood disorder onset) had a 2% predicted chance of conversion to bipolar spectrum, those with all risk factors had a 49% predicted chance of conversion. Conclusions Dimensional measures of anxiety/depression, affective lability, and mania are important predictors of new-onset bipolar spectrum in this population of at-risk youth. These symptoms emerged from among numerous other candidates, underscoring the potential clinical and research utility of these findings.

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Section: Resultsmentioning

confidence: 99%

Toward the Definition of a Bipolar Prodrome: Dimensional Predictors of Bipolar Spectrum Disorders in At-Risk Youths

Hafeman¹,

Merranko²,

Axelson³

et al. 2016

AJP

173

199

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“…Moreover, the small sample size may limit the generalization of findings, and certainly reduced statistical power for our comparison between subgroups. As this is an exploratory analysis, we chose not to correct for multiple comparisons, as done by Zeschel et al 33 To minimize the limitation posed by recall bias, we included only individuals who were clinically stable at the time of the study and limited the duration of illness to p 9 years. In addition, we assessed prodromal symptoms using a highly detailed instrument, which made it possible to differentiate traits and personality from emerging symptoms and to evaluate the severity and interference with functioning of each of the reported prodromal symptoms.…”

Section: Discussionmentioning

confidence: 99%

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

Noto

Caribé

et al. 2015

Rev. Bras. Psiquiatr.

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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.

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“…In three studies, for example, between 6.3% and 79.0% of patients identified feeling worthless or guilty as an initial prodrome of depressive episodes; this was produced by the interindividual variability of patients when they are experiencing prodromes [43] and by the heterogeneity of the procedures used to identify them. Interindividual variability depends, among other factors, on the stage of the patient's disorder, the presence or absence of psychotic symptoms in the most recent episode of the bipolar illness [31], patient temperament type [44], and the existence or not of comorbidity. Additionally, different types of methods with different response options were used to identify the prodromes.…”

Section: Initial and Relapse Prodromesmentioning

confidence: 99%

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

et al. 2020

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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.

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Temperament and prodromal symptoms prior to first manic/hypomanic episodes: Results from a pilot study

Cited by 21 publications

References 44 publications

Toward the Definition of a Bipolar Prodrome: Dimensional Predictors of Bipolar Spectrum Disorders in At-Risk Youths

Toward the Definition of a Bipolar Prodrome: Dimensional Predictors of Bipolar Spectrum Disorders in At-Risk Youths

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

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

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