title: The initial prodrome to bipolar affective disorder: prospective case studies.
abstract: BACKGROUND
  The initial prodrome to bipolar disorder has received very little attention to date, with most of the available data only addressing the prodrome to relapse. This study presents several prospective case studies of the initial prodrome to bipolar affective disorder.
  
  
  METHODS
  Three patients are presented who developed bipolar disorder during their treatment at the Personal Assessment and Crisis Evaluation Clinic (PACE). They were prospectively interviewed over a 12-month period using standard clinical research interviews.
  
  
  RESULTS
  These patients met the criteria for bipolar disorder by the end of the treatment period. Depressive symptoms were the main reason for their first clinical presentation, with mania developing at a later date. Other comorbidities were observed before they were diagnosed with bipolar disorder.
  
  
  CONCLUSIONS
  The generalisability of our findings was constrained because of the small sample size. Furthermore, our findings are likely to be influenced by the intake criteria used at PACE, a clinic that primarily aims at identifying patients at risk of psychosis rather than bipolar disorder.
  
  
  CONCLUSIONS
  Our study provides information about the initial prodrome to bipolar disorder, which has previously been neglected in research studies. We found there were no prodrome features that clearly distinguished between patients who go on to develop bipolar disorder and those who develop schizophrenia. We hope our prospective data will be the starting point for subsequent studies, with the aim of applying these findings to developing suitable preventative interventions for bipolar disorder.
authors.affiliation: PACE Clinic, Mental Health Services for Kids and Youth, University of Melbourne, Department of Psychiatry, Parkville, Victoria 3052, Australia.
authors.forename: Katherine N
authors.initials: KN
authors.lastname: Thompson
authors.forename: Philippe O
authors.initials: PO
authors.lastname: Conus
authors.forename: Janine L
authors.initials: JL
authors.lastname: Ward
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Phillips
authors.forename: John
authors.initials: J
authors.lastname: Koutsogiannis
authors.forename: Steven
authors.initials: S
authors.lastname: Leicester
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index