title: Clinical characteristics and influence of childhood trauma on the prodrome of bipolar disorder.
abstract: OBJECTIVE
  To describe the onset pattern, frequency, and severity of the signs and symptoms of the prodrome of the first hypomanic/manic episode and first depressive episode of bipolar disorder (BD) and to investigate the influence of a history of childhood maltreatment on the expression of prodromal symptoms.
  
  
  METHODS
  Using a semi-structured interview, the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), information regarding prodromal symptoms was assessed from patients with a DSM-IV diagnosis of BD. History of childhood maltreatment was evaluated using the Childhood Trauma Questionnaire (CTQ).
  
  
  RESULTS
  Forty-three individuals with stable BD were included. On average, the prodrome of mania lasted 35.8 ± 68.7 months and was predominantly subacute or insidious, with rare acute presentations. The prodrome of depression lasted 16.6 ± 23.3 months and was also predominantly subacute or insidious, with few acute presentations. The prodromal symptoms most frequently reported prior to the first hypomanic or manic episode were mood lability, depressive mood, and impatience. A history of childhood abuse and neglect was reported by 81.4% of participants. Presence of childhood maltreatment was positively associated with prodromal symptoms, including social withdrawal, decreased functioning, and anhedonia.
  
  
  CONCLUSIONS
  This study provides evidence of a long-lasting, symptomatic prodrome prior to first hypomanic/manic and depressive episode in BD and suggests that a history of childhood maltreatment influences the manifestations of this prodrome.
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Mariane N
authors.initials: MN
authors.lastname: Noto
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Noto
authors.affiliation: Program of Mood and Anxiety Disorders (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
authors.forename: André C
authors.initials: AC
authors.lastname: Caribé
authors.affiliation: Program of Mood and Anxiety Disorders (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil.
authors.forename: Ângela
authors.initials: Â
authors.lastname: Miranda-Scippa
authors.affiliation: Department of Clinical Medicine, Health Sciences Center, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil.
authors.forename: Sandra O
authors.initials: SO
authors.lastname: Nunes
authors.affiliation: First Psychotic Episode Program, Department of Psychiatry, UNIFESP, São Paulo, SP, Brazil.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Chaves
authors.affiliation: Ambulatório Médico de Especialidades (AME) Dra. Jandira Masur, São Paulo, SP, Brazil.
authors.forename: Denise
authors.initials: D
authors.lastname: Amino
authors.affiliation: Developmental Cognitive Neuroscience Research Group (GNCD), Center of Studies and Research in Trauma and Stress (NEPTE), Biomedical Research Institute (IPB), Pontificia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Grassi-Oliveira
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Elisa
authors.initials: E
authors.lastname: Brietzke
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000209:etiology / Q000523:psychology*; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology; D005260:Female; D006801:Humans; D000067562:Late Onset Disorders / Q000523:psychology; D008297:Male; D062706:Prodromal Symptoms; D011569:Psychiatric Status Rating Scales; D000067073:Psychological Trauma / Q000150:complications / Q000523:psychology*; D011594:Psychometrics; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors