Is There Validity to the Bipolar Prodrome?

Singh, Manpreet K.

doi:10.4088/jcp.14com09502

Cited by 6 publications

(4 citation statements)

References 17 publications

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“…39 Prodromal features and bipolar at-risk criteria It is becoming increasingly recognised that bipolar, like schizophrenia, has a prodromal phase which can be identified prior to development of the full illness. 132,133 However, one issue with research into this area is the potential conflation of the concepts of a prodrome for bipolar, referring to symptoms that can be retrospectively identified as preceding the onset of the disorder, and a 'risk syndrome' consisting of clinical features, comorbidities and risk factors which increase the risk of later developing bipolar. 134 At present, neither prodrome nor risk syndrome has been fully defined, although the bipolar at-risk (BAR) assessment tool has demonstrated predictive validity and reliability for identifying those at risk of bipolar, with around 23% of those identified transitioning to mania or hypomania.…”

Section: Environmental Risk Factorsmentioning

confidence: 99%

Epidemiology and risk factors for bipolar disorder

Rowland

Marwaha

2018

Therapeutic Advances in Psychopharmacology

367

177

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Bipolar disorder is a multifactorial illness with uncertain aetiology. Knowledge of potential risk factors enables clinicians to identify patients who are more likely to develop bipolar disorder, which directs further investigation, follow up and caution when prescribing. Ideally, identifying directly causative factors for bipolar disorder would enable intervention on an individual or population level to prevent the development of the illness, and improve outcomes through earlier treatment. This article reviews the epidemiology of bipolar disorder, along with putative demographic, genetic and environmental risk factors, while assessing the strength of these associations and to what extent they might be said to be 'causative'. While numerous genetic and environmental risk factors have been identified, the attributable risk of individual factors is often small, and most are not specific to bipolar disorder but are associated with several mental illnesses. Therefore, while some genetic and environmental factors have strong evidence supporting their association with bipolar disorder, fewer have sufficient evidence to establish causality. There is increasing interest in the role of specific gene-environment interactions, as well as the mechanisms by which risk factors interact to lead to bipolar disorder.

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Section: Environmental Risk Factorsmentioning

confidence: 99%

Epidemiology and risk factors for bipolar disorder

Rowland

Marwaha

2018

Therapeutic Advances in Psychopharmacology

367

177

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“…Consistent with the psychosis CHR state, general risk factors that increase the likelihood of developing bipolar disorder are relatively well known [28,59]. However, there is only little knowledge about factors that specifically increase the risk of conversion to full bipolar disorder in people within the bipolar CHR state [26,28,58]. Even more than in the psychosis CHR state, psychiatric comorbidities are very frequent in the bipolar CHR state as well as in established pediatric bipolar disorders [28,53,60].…”

Section: The Bipolar Chr Statementioning

confidence: 99%

Pharmacotherapy in Children and Adolescents at Clinical-High Risk for Psychosis and Bipolar Disorder

2016

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This review aims to describe the importance of i) detecting individuals at clinical high-risk for psychosis (schizophrenia) or bipolar disorder, especially in children and adolescents, in order to enable early intervention, and ii) evaluating different intervention strategies, especially pharmacotherapy, during the subsyndromal or "prodromal" stages of these severe and often debilitating disorders. The different approaches regarding the psychotic and bipolar clinical high-risk state are discussed, including reasons and evidence for early (pharmacological) intervention and risks of treatment vs. non-treatment. Only 10 prospective studies of antipsychotics (randomized=4) and 6 prospective studies of non-antipsychotic pharmacologic agents (randomized=3, i. e., omega-3 fatty acids=2, glycine=1) for the psychotic clinical high-risk state and only 4 prospective studies of mood stabilizing medications for the bipolar clinical high-risk state (randomized=2, i. e., lithium=1, valproate=1) were detected. Based on the minimal efficacy data, adverse effect risks, especially in pediatric populations, nonspecific psychopathology, and unknown true risk for the development of either psychosis or bipolar disorder or of chronically disabling symptoms and disability, medication treatment currently remains second choice after psychosocial intervention. Additional research in this area is clearly needed in order to shed more light on the relevance and predictive value of potentially prodromal symptoms, their identification and most appropriate management options.

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“…28,29 Several studies have recognized mood lability, major depressive episodes, subsyndromal manic symptoms, a diagnosis of a bipolar spectrum disorder (such as cyclothymia or BD not otherwise specified), and mood-congruent psychotic symptoms as precursors of BD. [30][31][32] On the other hand, in clinical practice, identification of a symptomatic high-risk BD phase is complicated by the complex nature of dimensions of this disorder, by potentially different symptom presentations in children and adolescents, 5,21,33 and by the blurred lines between the prodrome and the disease itself. 34 Retrospective and prospective studies have revealed a pattern of putative prodromal symptoms, of which mood lability/mood swings/cyclothymic features, depressive mood, racing thoughts, irritability, and physical agitation are most commonly reported.…”

Section: Clinical Presentation Of Early Stagesmentioning

confidence: 99%

Challenges and developments in research of the early stages of bipolar disorder

Brietzke

Rosa

Pedrini

et al. 2016

Rev. Bras. Psiquiatr.

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Recently, attention in the field of bipolar disorder (BD) has focused on prevention, including early detection and intervention, as these strategies have the potential to delay, lessen the severity, or even prevent full-blown episodes of BD. Although knowledge of the neurobiology of BD has advanced substantially in the last two decades, most research was conducted with chronic patients. The objective of this paper is to comprehensively review the literature regarding the early stages of BD, to explore recent discoveries on the neurobiology of these stages, and to discuss implications for research and clinical care. The following databases were searched: PubMed, PsycINFO, Cochrane Library, and SciELO. Articles published in English from inception to December 2015 were retrieved. Several research approaches were used, including examination of offspring studies, retrospective studies, prospective studies of clinical high-risk populations, and exploration of the progression after the first manic episode. Investigations with neuroimaging, cognition assessments, and biomarkers provide promising (although not definitive) evidence of alterations in the neural substrate during the at-risk stage. Research on BD should be expanded to encompass at-risk states and aligned with recent methodological progress in neuroscience.

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Is There Validity to the Bipolar Prodrome?

Cited by 6 publications

References 17 publications

Epidemiology and risk factors for bipolar disorder

Epidemiology and risk factors for bipolar disorder

Pharmacotherapy in Children and Adolescents at Clinical-High Risk for Psychosis and Bipolar Disorder

Challenges and developments in research of the early stages of bipolar disorder

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