Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode

Authors

  • Christoph U Correll,

    Corresponding author
    1. The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
    2. Hofstra North Shore–LIJ School of Medicine, Hempstead, NY
    3. The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY
    • Corresponding author:

      Christoph U. Correll, M.D.

      The Zucker Hillside Hospital

      Psychiatry Research

      75–59 263rd Street

      Glen Oaks, NY 11004

      USA

      Fax: 718-343-1659

      E-mail: ccorrell@lij.edu

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  • Marta Hauser,

    1. The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
    2. Hofstra North Shore–LIJ School of Medicine, Hempstead, NY
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  • Julie B Penzner,

    1. New York–Presbyterian Hospital/Weill Cornell Medical College, New York, NY
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  • Andrea M Auther,

    1. The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
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  • Vivian Kafantaris,

    1. The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
    2. Hofstra North Shore–LIJ School of Medicine, Hempstead, NY
    3. The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY
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  • Ema Saito,

    1. The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
    2. Hofstra North Shore–LIJ School of Medicine, Hempstead, NY
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  • Doreen Olvet,

    1. The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
    2. Department of Psychiatry and Behavioral Sciences, Stony Brook University, Stony Brook, NY
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  • Ricardo E Carrión,

    1. The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
    2. The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY
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  • Boris Birmaher,

    1. Department of Psychiatry, University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, Pittsburgh, PA
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  • Kiki D Chang,

    1. Department of Psychiatry, Stanford University School of Medicine, Stanford, CA
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  • Melissa P DelBello,

    1. Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH
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  • Manpreet K Singh,

    1. Department of Psychiatry, Stanford University School of Medicine, Stanford, CA
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  • Mani Pavuluri,

    1. Department of Psychiatry, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
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  • Barbara A Cornblatt

    1. The Zucker Hillside Hospital, Psychiatry Research, North Shore–Long Island Jewish Health System, Glen Oaks, NY
    2. Hofstra North Shore–LIJ School of Medicine, Hempstead, NY
    3. The Feinstein Institute for Medical Research, North Shore–Long Island Jewish Health System, Manhasset, NY
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Abstract

Objectives

The aim of the present study was to systematically evaluate the prodrome to mania in youth.

Methods

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.

Results

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.

Conclusions

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.

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