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.
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.
Authors: David A Axelson; Boris Birmaher; Michael A Strober; Benjamin I Goldstein; Wonho Ha; Mary Kay Gill; Tina R Goldstein; Shirley Yen; Heather Hower; Jeffrey I Hunt; Fangzi Liao; Satish Iyengar; Daniel Dickstein; Eunice Kim; Neal D Ryan; Erica Frankel; Martin B Keller Journal: J Am Acad Child Adolesc Psychiatry Date: 2011-09-08 Impact factor: 8.829
Authors: Ellen Leibenluft; Patricia Cohen; Tristan Gorrindo; Judith S Brook; Daniel S Pine Journal: J Child Adolesc Psychopharmacol Date: 2006-08 Impact factor: 2.576
Authors: David J Miklowitz; Kiki D Chang; Dawn O Taylor; Elizabeth L George; Manpreet K Singh; Christopher D Schneck; L Miriam Dickinson; Meghan E Howe; Judy Garber Journal: Bipolar Disord Date: 2011-02 Impact factor: 6.744
Authors: Manon Hj Hillegers; Catrien G Reichart; Marjolein Wals; Frank C Verhulst; Johan Ormel; Willem A Nolen Journal: Bipolar Disord Date: 2005-08 Impact factor: 6.744
Authors: Robert K McNamara; Jeffrey R Strawn; Max J Tallman; Jeffrey A Welge; L Rodrigo Patino; Thomas J Blom; Melissa P DelBello Journal: J Child Adolesc Psychopharmacol Date: 2020-03-11 Impact factor: 2.576
Authors: Jessica C Levenson; Adriane Soehner; Brian Rooks; Tina R Goldstein; Rasim Diler; John Merranko; David Axelson; Ben I Goldstein; David A Brent; Danella Hafeman; Mary Beth Hickey; Kelly Monk; Dara Sakolsky; David J Kupfer; Boris Birmaher Journal: J Affect Disord Date: 2017-03-06 Impact factor: 4.839
Authors: Robert K McNamara; Ann B Moser; Richard I Jones; Ronald Jandacek; L Rodrigo Patino; Jeffrey R Strawn; Stephen M Strakowski; Melissa P DelBello Journal: Psychiatry Res Date: 2016-10-25 Impact factor: 3.222
Authors: Boris Birmaher; John A Merranko; Tina R Goldstein; Mary Kay Gill; Benjamin I Goldstein; Heather Hower; Shirley Yen; Danella Hafeman; Michael Strober; Rasim S Diler; David Axelson; Neal D Ryan; Martin B Keller Journal: J Am Acad Child Adolesc Psychiatry Date: 2018-08-07 Impact factor: 8.829
Authors: Jessica Dagani; Giulia Signorini; Olav Nielssen; Moira Bani; Adriana Pastore; Giovanni de Girolamo; Matthew Large Journal: Can J Psychiatry Date: 2016-07-11 Impact factor: 4.356
Authors: Gustavo Scola; Robert K McNamara; Paul E Croarkin; Jarrod M Leffler; Kathryn R Cullen; Jennifer R Geske; Joanna M Biernacka; Mark A Frye; Melissa P DelBello; Ana C Andreazza Journal: J Affect Disord Date: 2015-12-23 Impact factor: 4.839