Predicting bipolar disorder on the basis of phenomenology: implications for prevention and early intervention

Authors

  • Gin S Malhi,

    Corresponding author
    1. Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
    2. Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
    • Corresponding author:

      Professor Gin S. Malhi

      Department of Psychiatry

      University of Sydney

      CADE Clinic

      Royal North Shore Hospital

      Level 5, Building 36

      St. Leonards

      NSW 2065

      Australia

      Fax: +61-2-9926-7730

      E-mail: gin.malhi@sydney.edu.au

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  • Danielle M Bargh,

    1. Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
    2. Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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  • Carissa M Coulston,

    1. Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
    2. Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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  • Pritha Das,

    1. Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia
    2. Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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  • Michael Berk

    1. School of Medicine, Deakin University, Geelong, Australia
    2. Department of Psychiatry, University of Melbourne, Melbourne, Australia
    3. Orygen Research Centre, Melbourne, Australia
    4. Mental Health Research Institute, Parkville, Vic., Australia
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Abstract

Objective

Bipolar disorder is a multifaceted illness and there is often a substantial delay between the first onset of symptoms and diagnosis. Early detection has the potential to curtail illness progression and disorder-associated burden but it requires a clear understanding of the initial bipolar prodrome. This article summarizes the phenomenology of bipolar disorder with an emphasis on the initial prodrome, the evolution of the illness, and the implications for prevention and early intervention.

Methods

A literature review was undertaken using Medline, Web of Science, and a hand search of relevant literature using keywords (e.g., phenomenology, initial or early symptoms, risk factors, and predictors/prediction). Findings from the literature were reviewed and synthesized and have been put into a clinical context.

Results

Bipolar disorder is a recurrent, persistent, and disabling illness that typically develops in adolescence or early adulthood. The literature search yielded 28 articles, in which mood lability, nonspecific, non-mood symptoms, and cyclothymic temperament were the most cited prodromal features.

Conclusions

A small number of key prospective studies have provided evidence in support of an initial bipolar prodrome; however, methodological differences across studies have prohibited its clear delineation. It is, therefore, not currently possible to anticipate those who will develop bipolar disorder solely on the basis of early phenomenology. Accurate characterization of the bipolar disorder prodrome through high-quality, prospective research studies with adequate control groups will ultimately facilitate prompt and accurate diagnosis.

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