Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode
Article first published online: 5 MAR 2014
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Special Issue: Guest Editors – Roger S. McIntyre and Christoph U. Correll
Volume 16, Issue 5, pages 478–492, August 2014
How to Cite
Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode. Bipolar Disord 2014: 16: 478–492. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd., , , , , , , , , , , , , .
- Issue published online: 4 AUG 2014
- Article first published online: 5 MAR 2014
- Manuscript Accepted: 10 JAN 2014
- Manuscript Received: 4 JAN 2013
- National Institute of Mental Health (NIMH). Grant Numbers: MH 61523-08, MH60845
- Feinstein Institute for Medical Research
- Zucker Hillside Hospital Advanced Center for Intervention and Services Research for the Study of Schizophrenia. Grant Number: P30MH090590
- bipolar disorder;
- clinical high risk;
- early recognition;
The aim of the present study was to systematically evaluate the prodrome to mania in youth.
New-onset/worsening symptoms/signs of ≥ moderate severity preceding first mania were systematically assessed in 52 youth (16.2 ± 2.8 years) with a research diagnosis of bipolar I disorder (BD-I). Youth and/or caregivers underwent semi-structured interviews, using the Bipolar Prodrome Symptom Scale–Retrospective.
The mania prodrome was reported to start gradually in most youth (88.5%), with either slow (59.6%) or rapid (28.8%) deterioration, while a rapid-onset-and-deterioration prodrome was rare (11.5%). The manic prodrome, conservatively defined as requiring ≥ 3 symptoms, lasted 10.3 ± 14.4 months [95% confidence interval (CI): 6.3–14.4], being present for ≥ 4 months in 65.4% of subjects. Among prodromal symptoms reported in ≥ 50% of youth, three were subthreshold manic in nature (irritability: 61.5%, racing thoughts: 59.6%, increased energy/activity: 50.0%), two were nonspecific (decreased school/work functioning: 65.4%, mood swings/lability: 57.7%), and one each was depressive (depressed mood: 53.8%) or subthreshold manic/depressive (inattention: 51.9%). A decreasing number of youth had ≥ 1 (84.6%), ≥ 2 (48.1%), or ≥ 3 (26.9%) ‘specific’ subthreshold mania symptoms (i.e., elation, grandiosity, decreased need for sleep, racing thoughts, or hypersexuality), lasting 9.5 ± 14.9 months (95% CI: 5.0–14.0), 3.5 ± 3.5 months (95% CI: 2.0–4.9), and 3.0 ± 3.2 months (95% CI: 1.0–5.0) for ≥ 1, ≥ 2, or ≥ 3 specific symptoms, respectively.
In youth with BD-I, a relatively long, predominantly slow-onset mania prodrome appears to be common, including subthreshold manic and depressive psychopathology symptoms. This suggests that early clinical identification and intervention may be feasible in bipolar disorder. Identifying biological markers associated with clinical symptoms of impending mania may help to increase chances for early detection and prevention before full mania.