The Bipolar Prodrome: Meta-Analysis of Symptom Prevalence Prior to Initial or Recurrent Mood Episodes

Meter, Anna Van; Burke, Coty; Youngstrom, Eric A.; Faedda, Gianni L.; Correll, Christoph U.

doi:10.1016/j.jaac.2016.04.017

Cited by 141 publications

(135 citation statements)

References 96 publications

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“…Because early treatment is associated with better outcomes for youth with bipolar spectrum disorders (Elanjithara et al, 2011), and because some data suggest that medications commonly used for other disorders (e.g., anti-depressants and stimulants) are less effective and can be harmful (Goldsmith et al, 2011; Pacchiarotti et al, 2013), accurate diagnosis and intervention is essential. Of course, the diagnostic picture can change over time – particularly for young people – but the presence of manic symptoms is associated with later bipolar disorder in many youth (Van Meter et al, 2016), and should be weighed accordingly when considering next clinical steps.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal course and characteristics of cyclothymic disorder in youth

Meter

Youngstrom

Birmaher

et al. 2017

Journal of Affective Disorders

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Objectives Epidemiological studies suggest that cyclothymic disorder is the most prevalent subtype of bipolar disorder (BD). However, it is rarely diagnosed, especially in youth. This may be because it can be difficult to ascertain whether a youth meets diagnostic criteria. Clearer, easy-to-apply criteria could reduce misdiagnosis. The objective of this study was to determine whether proposed research diagnostic criteria for cyclothymic disorder (RDCyc), based on DSM-5 criteria, could be quantified and validated in youth. Methods Participants from the Longitudinal Assessment of Manic Symptoms (LAMS) study were recruited based on symptoms of mania and followed prospectively. RDCyc criteria were: 1) At least one core symptom each of mania and depression; 2) one additional symptom of mania and of depression; 3) persistence over two consecutive six-month periods, and 4) impairment. Exclusionary criteria were having a [hypo]manic or depressive episode. Outcomes at the two-year follow-up were compared between RDCyc youth and other diagnostic groups (BD I/II, BD NOS/non-RDCyc cyclothymic disorder, disruptive behavior disorders [DBD], depression). Results Thirty-seven youth met RDCyc criteria. There were no consistent differences between the RDCyc youth and youth with other BD subtypes (ps=.001–.960, with all-but-one p value >.02). RDCyc youth had higher depression (p<.0005) and mania scores (p=.001), lower functioning (p=.012), and higher suicide risk than DBD youth (p=.001). They had higher mania scores than depressed youth (p.018). Limitations The majority of youth in the sample were recruited due to elevated symptoms of mania, which may limit the generalizability of the results. Youth were followed for two years, which may not be long enough to determine whether or not they will eventually develop a manic or depressive episode. Conclusions Applying RDCyc criteria identified youth who were similar to others with BD and were more impaired than those with DBD. Using these criteria could reduce misdiagnosis and increase our understanding of this prevalent, but largely ignored, diagnosis.

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Section: Discussionmentioning

confidence: 99%

Longitudinal course and characteristics of cyclothymic disorder in youth

Meter

Youngstrom

Birmaher

et al. 2017

Journal of Affective Disorders

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“…92 The prodrome of BD-I or BD-II, often identified retrospectively in adult studies, commonly involves attenuated mood symptoms; and sleep disturbance may be a marker clinically (see reference for detailed discussion of prodrome). 93 …”

Section: | Clinical Characteristics Differential Diagnoses and Comentioning

confidence: 99%

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

et al. 2017

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Objectives Over the past two decades, there has been tremendous growth in research regarding bipolar disorder (BD) among children and adolescents (ie, pediatric BD [PBD]). The primary purpose of this article is to distill the extant literature, dispel myths or exaggerated assertions in the field, and disseminate clinically relevant findings. Methods An international group of experts completed a selective review of the literature, emphasizing areas of consensus, identifying limitations and gaps in the literature, and highlighting future directions to mitigate these gaps. Results Substantial, and increasingly international, research has accumulated regarding the phenomenology, differential diagnosis, course, treatment, and neurobiology of PBD. Prior division around the role of irritability and of screening tools in diagnosis has largely abated. Gold-standard pharmacologic trials inform treatment of manic/mixed episodes, whereas fewer data address bipolar depression and maintenance/continuation treatment. Adjunctive psychosocial treatment provides a forum for psychoeducation and targets primarily depressive symptoms. Numerous neurocognitive and neuroimaging studies, and increasing peripheral biomarker studies, largely converge with prior findings from adults with BD. Conclusions As data have accumulated and controversy has dissipated, the field has moved past existential questions about PBD toward defining and pursuing pressing clinical and scientific priorities that remain. The overall body of evidence supports the position that perceptions about marked international (US vs elsewhere) and developmental (pediatric vs adult) differences have been overstated, although additional research on these topics is warranted. Traction toward improved outcomes will be supported by continued emphasis on pathophysiology and novel therapeutics.

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“…Early identification of those at above-average risk can be offered prospective monitoring that allows for more intensive early intervention if symptoms escalate. A recent meta-analysis observed that the initial prodromal period, whilst quite extended (about 27 months), is characterized by symptoms that are largely consistent with the subsequent mood episode (Van Meter et al 2016). Of course, a further potential benefit of studying risk syndromes is that it offers a means to link clinical phenotypes to endophenotypes and biomarkers to examine their validity (Hickie et al 2013).…”

Section: Defining the Conceptsmentioning

confidence: 99%

Prodrome or risk syndrome: what’s in a name?

Geoffroy

Scott

2017

Int J Bipolar Disord

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Background In the last decade, an increasing number of publications have examined the precursors of bipolar disorders (BD) and attempted to clarify the early origins and illness trajectory. This is a complex task as the evolution of BD often shows greater heterogeneity than psychosis, and the first onset episode of BD may be dominated by depressive or manic features or both. To date, most of the published reviews have not clarified whether they are focused on prodromes, risk syndromes or addressing both phenomena. To assist in the interpretation of the findings from previous reviews and independent studies, this paper examines two concepts deemed critical to understanding the pre-onset phase of any mental disorder: prodromes and risk syndromes. The utility of these concepts to studies of the evolution of bipolar disorder (BD) is explored.FindingsThe term “prodrome” is commonly used to describe the symptoms and signs that precede episode onset. If strictly defined, the term should only be applied retrospectively as it refers to cohorts of cases that all progress to meet diagnostic criteria for a specific disorder and gives insights into equifinality. Whilst prodromes may reliably predict individual relapses, the findings cannot necessarily be extrapolated to identify prospectively who will develop a first episode of a specific disorder from within a given population. In contrast, ‘risk syndrome’ is a term that encompasses sub-threshold symptom clusters, but has often been extended to include other putative risk factors such as family history, or other variables expressed continuously in the population, such as personality traits. Only a minority of individuals ‘at risk’ make the transition to a specific mental disorder. By prospectively observing those cases where the risk syndrome does not progress to severe disorder or progress to a non-BD condition, we gain insights into the discriminant validity of different pre-BD characteristics, pluripotentiality of outcomes, and protective factors and resilience.ConclusionWe emphasize the clinical and research utility of prodromes and risk syndromes, examine examples of the conflation of the concepts, and highlight the rationale for regarding them as discrete entities.

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The Bipolar Prodrome: Meta-Analysis of Symptom Prevalence Prior to Initial or Recurrent Mood Episodes

Cited by 141 publications

References 96 publications

Longitudinal course and characteristics of cyclothymic disorder in youth

Longitudinal course and characteristics of cyclothymic disorder in youth

The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research

Prodrome or risk syndrome: what’s in a name?

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