The Significance of At-Risk or Prodromal Symptoms for Bipolar I Disorder in Children and Adolescents

Abstract

Background While in the early identification and intervention of psychosis, specific instruments and risk criteria have been generated and validated, research into preventive strategies for bipolar-I disorder (BP-I) has only recently gained momentum. Since first signs of BP-I often start before adulthood, such efforts are especially important in the vulnerable pediatric population. Methods Narrative review of data regarding the presence and nature of potentially prodromal, i.e., sub-syndromal, symptoms prior to BP-I, defined by first-episode mania, focusing on pediatric patients. Results The possibility of early identification of youth at high-risk for BP is supported by retrospective studies of BP-I patients, and prospective studies of community samples, offspring of BP-I subjects, youth with depressive disorders, and patients at high-risk for psychosis or with BP-spectrum disorders without lifetime history of mania. These data provide essential insight into potential signs and symptoms that may enable pre-syndromal identification of BP-I in youth. However, except for offspring studies, broader prospective approaches that focus on youth at risk for BP-I and on developing specific interviews/rating scales and risk criteria are mostly missing, or in their early stage. Conclusions More work is needed to determine valid clinical high-risk criteria, to distinguish risk factors, endophenotypes and comorbidities from specific prodromal symptomatology, and to develop phase-specific interventions that titrate the risk of intervention to the risk of transition to mania and to functional impairment or distress. Moreover, studies are needed that determine potential differences in prodromal symptoms and trajectories between children, adolescents and adults, and the best phase-specific interventions.

Toward the Definition of a Bipolar Prodrome: Dimensional Predictors of Bipolar Spectrum Disorders in At-Risk Youths

“…We add to this work by finding that subsyndromal manic symptoms (even in the absence of a mood episode) predict bipolar spectrum onset in at-risk youth. Our results are also consistent with findings from retrospective and at-risk studies that point to a wide-ranging set of prodromal symptoms, in particular, anxiety/depression (26,27), affective lability (17,44,45), and subthreshold manic symptoms (45,46) [reviewed in (9)]. We find that almost all dimensions are elevated in youth at-risk for disorder (as compared to community control offspring).…”

“…Based on retrospective studies of both adults and children, sleep disturbances, anxiety, depressive symptoms, affective lability, subthreshold hypomanic symptoms, behavioral dyscontrol, and irritability have been reported to precede bipolar disorder (3,7–9). Many of these characteristics have also been identified in youth at genetic risk for bipolar disorder (10–18).…”

Descripción de perfiles psicopatológicos y neurocognitivos de hijos de pacientes con trastorno bipolar tipo I dentro un programa de intervencion multimodal: PRISMA

“…También se han reportado tasas elevadas de trastornos de ánimo (diferentes del TB), trastornos de ansiedad y trastornos disruptivos 33 . Un estudio prospectivo, realizado en una población Amish con un seguimiento de 16 años 5 , identificó síntomas subsindromales de manía 9 años antes del inicio del TB claramente manifiesto; entre los más frecuentemente observados se encontraron dificultades en la concentración, alteraciones en la psicomotricidad, ansiedad, insomnio, labilidad emocional y comportamientos grandiosos y audaces; los primeros tres también se evidenciaron en nuestro estudio 5,[36][37][38][39][40][41][42] .…”

Early stages of bipolar disorder: characterization and strategies for early intervention

“…In general, high-risk criteria involve having a first-degree relative with BD or schizophrenia, a history of subthreshold mood or psychotic symptoms, and being in the age range most frequently associated with onset of BP or schizophrenia (i.e., adolescence). 25 Recently, a research group proposed a preliminary definition of bipolar at-risk (BAR) criteria for use in prospective studies. The authors proposed to consider that initial phases of BD may feature symptoms that are insufficient in frequency, severity, or duration to characterize the full-blown disease, but that can represent a high risk of transition to BD in a short period of time.…”

“…[22][23][24] The paradigm of early intervention in this disorder has led to the spread of mental health services focused on early psychosis, an initiative shown to lead to more favorable long-term outcomes and that is cost-effective. 25,26 The objective of this study was to review the literature related to the characterization of the early stages of BD, defined as the clinical prodrome/subsyndromal stage and first-episode phase, and to their respective treatment.…”