The bipolar disorder prodrome revisited: Is there a symptomatic pattern?
OBJECTIVE
To assess the phenomenology and course of pre-(hypo)manic and pre-depressed prodromal symptoms, including mood swings, as precursors of bipolar disorder (BD) in a German multi-center study.


METHODS
Semi-structured interviews [Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R); Semi-structured Interview for Mood Swings] were administered to patients within 8 years of BD (BD I, BD II) onset.


RESULTS
Forty two outpatients were included (40.5% male, mean age 35.1±10.0 years, illness onset at 30.5±9.5 years). Feeling extremely energetic (85.7%), racing thoughts (78.6%), physical agitation (76.2%), overtalkativeness (71.4%), and low sleep requirement (71.4%) occurred most frequently prior to the first (hypo)manic episode, whereas depressed mood (83.0%), reduced vitality (81.0%), physical exhaustion (78.6%), tiredness (76.2%), and insomnia (66.7%) preceded pre-depressively. Mood lability (p=.006), odd ideas (p=.003) and the psychosis index score (p=.003) differed significantly in prevalence depending on the episodes' mood. Extremely energetic (p=.046), overtalkativeness (p<.001), and racing thoughts (p=.013) lasted significantly longer prior to depression. Neither severity nor frequency of prodromal symptoms differed significantly. Most of the symptoms emerged during the proximal prodromal phase. Links between mood swings and subsequent BD were found.


CONCLUSIONS
Symptoms were evaluated retrospectively with self-reporting tools in bipolar patients from academic treatment settings without comparison to clinical controls.


CONCLUSIONS
Not only specific depressive or manic but also general symptoms occurred prior to both affective episodes. The pre-depressive prodrome lasted longer than the pre-manic one, but severity and frequency did not differ significantly. Mood swings and disturbed diurnal rhythm occurred prior to both episodes as early signs of BD.
Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, LWL-Universitätsklinikum Bochum, Germany. Electronic address: eike.zeschel@wkp-lwl.org.
Eike
E
Zeschel
Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA.
Christoph U
CU
Correll
Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, LWL-Universitätsklinikum Bochum, Germany.
Ida S
IS
Haussleiter
Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, LWL-Universitätsklinikum Bochum, Germany.
Seza
S
Krüger-Özgürdal
Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany.
Karolina
K
Leopold
Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany.
Andrea
A
Pfennig
Department of Psychiatry and Psychotherapy, University of Cologne, Germany.
Andreas
A
Bechdolf
Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany.
Michael
M
Bauer
Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, LWL-Universitätsklinikum Bochum, Germany.
Georg
G
Juckel
D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062706:Prodromal Symptoms; D012189:Retrospective Studies; D055815:Young Adult
Bipolar disorder; Early recognition; Mania; Mood swings; Prodrome