Mariane N Noto1, Cristiano Noto1, André C Caribé2, Ângela Miranda-Scippa2, Sandra O Nunes3, Ana C Chaves4, Denise Amino5, Rodrigo Grassi-Oliveira6, Christoph U Correll7, Elisa Brietzke1. 1. 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. 2. Program of Mood and Anxiety Disorders (CETHA), Universidade Federal da Bahia (UFBA), Salvador, BA, Brazil. 3. Department of Clinical Medicine, Health Sciences Center, Universidade Estadual de Londrina (UEL), Londrina, PR, Brazil. 4. First Psychotic Episode Program, Department of Psychiatry, UNIFESP, São Paulo, SP, Brazil. 5. Ambulatório Médico de Especialidades (AME) Dra. Jandira Masur, São Paulo, SP, Brazil. 6. 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. 7. The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, NY, USA.
Abstract
OBJECTIVES: 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.
OBJECTIVES: 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.
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