Prodromal Symptoms Before Onset of Manic-Depressive Disorder Suggested by First Hospital Admission Histories

Egeland, Janice A.; Hostetter, Abram M.; Pauls, David L.; Sussex, Jon

doi:10.1097/00004583-200010000-00011

Cited by 157 publications

(144 citation statements)

References 15 publications

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“…The cyclothymic children also had more depressive episodes at follow-up, more psychotic symptoms, more suicidal ideation and attempts, and more instances of antidepressant-induced hypomanic or manic episodes. Cyclothymic children were described, at baseline, as highly mood-labile and emotionally overactive, explosively angry, impulsive, aggressive, and emotionally hypersensitive, much as the studies by and Egeland et al (2000Egeland et al ( , 2003 had described. Young adults with these cyclothymic temperaments have been found to have a high familial loading for affective disorder (Akiskal, 1995).…”

Section: Longitudinal Studiesmentioning

confidence: 96%

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

Miklowitz

Chang

2008

Dev Psychopathol

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This article examines how bipolar symptoms emerge during development, and the potential role of psychosocial and pharmacological interventions in the prevention of the onset of the disorder. Early signs of bipolarity can be observed among children of bipolar parents and often take the form of subsyndromal presentations (e.g., mood lability, episodic elation or irritability, depression, inattention, and psychosocial impairment). However, many of these early presentations are diagnostically nonspecific. The few studies that have followed at-risk youth into adulthood find developmental discontinuities from childhood to adulthood. Biological markers (e.g., amygdalar volume) may ultimately increase our accuracy in identifying children who later develop bipolar I disorder, but few such markers have been identified. Stress, in the form of childhood adversity or highly conflictual families, is not a diagnostically-specific causal agent but does place genetically and biologically vulnerable individuals at risk for a more pernicious course of illness. A preventative family-focused treatment for children with (a) at least one first-degree relative with bipolar disorder, and (b) subsyndromal signs of bipolar disorder, is described. This model attempts to address the multiple interactions of psychosocial and biological risk factors in the onset and course of bipolar disorder.

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Section: Longitudinal Studiesmentioning

confidence: 96%

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

Miklowitz

Chang

2008

Dev Psychopathol

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“…[97][98][99][100][101][102][103] Further, the UHR criteria described above, which were defined with the prediction of nonaffective psychosis in mind, lead to a heterogeneous range of diagnoses across the spectrum of psychosis, including psychotic depression and mania. 38 Before the onset Häfner et al 105 failed to distinguish the prodromal stage of schizophrenia from that of depression in a retrospective study.…”

Section: Risk Syndromes Staging and Early Intervention For Mood Dismentioning

confidence: 99%

Clinical Staging: A Heuristic and Practical Strategy for New Research and Better Health and Social Outcomes for Psychotic and Related Mood Disorders

et al. 2010

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Highlights • A clinical staging model mapping the development, progression, and extension of mental illness over time, may prove to be heuristically and practically useful in clinical practice and basic research. • Clinical staging will aid clinicians to select treatments that are particularly relevant to the earlier stages of illness, when such interventions are likely to be more effective and less harmful than those delivered later in the course of illness. • Clinical staging will allow more precise mapping of the relations between known biological markers and psychosocial risk factors and stage of illness, enabling better integration and representation of knowledge.

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“…This dimensional approach may be more sensitive and informative in the search for determinants of onset and change, making it easier to monitor onset and progression of psychiatric phenotypes (Cougnard et al 2007 ;van Os et al 2009). Furthermore, it allows for fuller examination of the impact of symptoms on well-being and functioning, severity and distress (Regeer et al 2006), and may facilitate recognition of at-risk states and early intervention (Egeland et al 2000 ;Hanssen et al 2005 ;Birmaher & Axelson, 2006). For bipolar disorder, it has the additional advantage of allowing for the separate study of manic and depressive dimensions, the co-occurrence of which in the same mood episode is common in clinical practice and therefore represents an important parameter for study in epidemiological and taxonomic investigations.…”

Section: Introductionmentioning

confidence: 99%

Evidence that bipolar disorder is the poor outcome fraction of a common developmental phenotype: an 8-year cohort study in young people

Tijssen

Wittchen

et al. 2009

Psychol. Med.

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Background. Reported rates of bipolar syndromes are highly variable between studies because of age differences, differences in diagnostic criteria, or restriction of sampling to clinical contacts.Method. In 1395 adolescents aged 14-17 years, DSM-IV (hypo)manic episodes (manic and hypomanic episodes combined), use of mental health care, and five ordinal subcategories representing the underlying continuous score of (hypo)manic symptoms (' mania symptom scale ') were measured at baseline and approximately 1.5, 4 and 10 years later using the Munich-Composite International Diagnostic Interview (DIA-X/M-CIDI).Results. Incidence rates (IRs) of both (hypo)manic episodes and (hypo)manic symptoms (at least one DSM-IV core symptom) were far higher (714/105 person-years and 1720/10 5 person-years respectively) than traditional estimates. In addition, the risk of developing (hypo)manic episodes was very low after the age of 21 years [hazard ratio (HR) 0.031, 95 % confidence interval (CI) 0.0050-0.19], independent of childhood disorders such as attention deficit hyperactivity disorder (ADHD). Most individuals with hypomanic and manic episodes were never in care (87 % and 62 % respectively) and not presenting co-morbid depressive episodes (69 % and 60 % respectively). The probability of mental health care increased linearly with the number of symptoms on the mania symptom scale. The incidence of the bipolar categories, in particular at the level of clinical morbidity, was strongly associated with previous childhood disorders and male sex.Conclusions. This study showed, for the first time, that experiencing (hypo)manic symptoms is a common adolescent phenomenon that infrequently predicts mental health care use. The findings suggest that the onset of bipolar disorder can be elucidated by studying the pathway from non-pathological behavioural expression to dysfunction and need for care.

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Prodromal Symptoms Before Onset of Manic-Depressive Disorder Suggested by First Hospital Admission Histories

Cited by 157 publications

References 15 publications

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations

Clinical Staging: A Heuristic and Practical Strategy for New Research and Better Health and Social Outcomes for Psychotic and Related Mood Disorders

Evidence that bipolar disorder is the poor outcome fraction of a common developmental phenotype: an 8-year cohort study in young people

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