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A comprehensive review and model of putative prodromal features of bipolar affective disorder

Published online by Cambridge University Press:  14 September 2010

O. D. Howes ,
S. Lim ,
G. Theologos ,
A. R. Yung ,
G. M. Goodwin  and
P. McGuire
O. D. Howes*
Affiliation:
Psychiatric Imaging Group, MRC Clinical Sciences Centre, Imperial College Hammersmith Campus, London, UK Section of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
S. Lim
Affiliation:
Section of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
G. Theologos
Affiliation:
Section of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
A. R. Yung
Affiliation:
Department of Psychiatry, University of Melbourne, Melbourne, Australia
G. M. Goodwin
Affiliation:
University Department of Psychiatry, University of Oxford, Oxford, UK
P. McGuire
Affiliation:
Section of Neuroimaging, Institute of Psychiatry, King's College London, London, UK
*
*Address for correspondence: Dr O. D. Howes, Box 67, Institute of Psychiatry, De Crespigny Park, Camberwell, LondonSE5 8AF, UK. (Email: oliver.howes@kcl.ac.uk)
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Abstract

Background

Identifying prodromal features that predate the onset of bipolar disorder (BD) may enable the prevention of BD and aid early intervention. This review addresses two key questions: Is there a bipolar prodrome? And, if there is, what are its characteristic features?

Method

A comprehensive search of databases (PubMed, Medline, EMBASE and PsycINFO) supplemented by hand searches was used to identify studies of symptoms preceding the onset of BD.

Results

Fifty-nine studies were identified, of which 14 met inclusion criteria. Symptoms can predate the onset of BD by months to years and can be categorized as attenuated forms of BD symptoms, general symptoms common to a range of mental disorders, and personality traits, particularly cyclothymia. Two studies provided sufficient data to enable sensitivity and specificity to be calculated. Specificity of several of the features was high (>90%) but sensitivity was generally low (all <60%). We propose a model based on the findings in the studies reviewed to illustrate the potential trajectory to BD and the points at which it may be possible to intervene.

Conclusions

Clinical features preceding the onset of BD can be identified. However, conclusions about whether there is a distinct prodrome to BD are restricted by the limitations of current evidence. The high specificity of some features suggests they may be useful in clinical practice. Large-scale longitudinal studies are needed to validate these features and characterize their specificity and sensitivity in independent samples.

Keywords

Affective disordersbipolar disorderearlyhypomaniaidentificationinterventionmaniaonsetprecursorprodromalprodromesymptomsriskrisk factors
Type
Review Article
Information
Psychological Medicine , Volume 41 , Issue 8 , August 2011 , pp. 1567 - 1577
Copyright
Copyright © Cambridge University Press 2010

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