Only half of bipolar I and II patients report prodromal symptoms

• Published in: Journal of affective disorders 2008-12, Vol.111 (2), p.366-371
• Main Authors: Mantere, Outi, Suominen, Kirsi, Valtonen, Hanna M, Arvilommi, Petri, Isometsä, Erkki
• Format: Article
• Language: English
• Subjects: Adult; Adult and adolescent clinical studies; Affective Symptoms - diagnosis; Affective Symptoms - epidemiology; Affective Symptoms - psychology; Ambulatory Care; Biological and medical sciences; Bipolar affective disorder; Bipolar Disorder - diagnosis; Bipolar Disorder - epidemiology; Bipolar Disorder - psychology; Bipolar disorders; Bipolar I and II disorder; Comorbidity; Cross-Sectional Studies; Depression; Depressive mixed states; Diagnostic and Statistical Manual of Mental Disorders; Female; Hospitalization; Humans; Male; Medical sciences; Mood disorders; Moods; Prevalence; Prodromal symptoms; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Surveys and Questionnaires
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2008.03.011

Abstract Background Learning to detect prodromal symptoms is a key element of psychosocial treatment of bipolar disorder (BD). However, previous studies have described only prodromes of manic and depressive phases of BD I patients, while information on prodromes in BD II, or other phases is lacking. Methods The Jorvi Bipolar Study included 191 in- and outpatients with DSM-IV BD (90 BD I, 101 BD II) in any acute phase of illness at baseline. The prevalence, type and duration of preceding prodromes were investigated using open-ended questions. The effects of type I or II disorder, index phase, socio-demographic factors, comorbidity, illness history and other correlates on report and duration of prodromes were investigated. Results Prodromes were reported by 45.0% of BD I and 50.0% of BD II patients. The first prodromal symptom was usually mood congruent, but sometimes non-specific for mood or a symptom of anxiety; the median duration was 30.5 days. No differences between BD I and II, or between patients who did and those who did not report prodromes were found. Only Axis I comorbidity associated with longer prodromes, but not independently after adjusting for age, gender and type of phase. Limitations The study was cross-sectional. Reporting prodromes depends on patients' insight which was likely affected by a sub-acute phase at time of interview. Conclusions Only half of ordinary, secondary care bipolar patients are able to report prodromes. The chronic and fluctuating course of illness, and sometimes short time interval to full episode may limit the potentials of prodrome-based interventions.