MedWire News: Although mood and energy dysregulation are characteristic of the initial prodrome of bipolar disorder, their low specificity does not allow the prediction of bipolar disorder development, conclude Norwegian researchers.

Up to 10 years may elapse between bipolar disorder onset and a correct diagnosis, with untreated illness resulting in more episodes, more severe episodes, and rapid cycling. Consequently, it would be beneficial to be able to detect bipolar disorder before full illness onset.

To investigate further, Dag Skjelstad, from Buskerud University, and colleagues searched the PsychINFO, PubMed, EMBASE, and British Nursing Index databases for original studies of the symptoms, signs, and temporal aspects of initial bipolar prodrome.

In all, eight studies, involving a total of 1625 patients, met the inclusion criteria, the team reports in Journal of Affective Disorders. Just two of the studies included control groups.

Taken together, the findings indicate that the common symptoms and signs of the initial prodrome of bipolar disorder were irritability and aggressiveness, sleep disturbances, depression and mania symptoms and signs, hyperactivity, anxiety, and mood swings.

The results also showed that, once full bipolar disorder onset approaches, symptoms of mania and depression increased in strength and prevalence. Interestingly, the specificity of prodromal symptoms for predicting bipolar disorder was low, demonstrating significant overlap with attention deficit-hyperactivity disorder and explaining just 10-14% of the variance in bipolar disorder compared with other groups.

The average duration of the initial prodrome of bipolar disorder was found to vary greatly between studies, ranging from 1.8 years to 7.3 years, with the duration seemingly longer when the first major depressive episode was counted as a mania prodrome.

The team concludes: “It is neither possible nor advisable to predict the development of bipolar disorder based solely on early phenomenology.

“Sudden and severe episodes of inexplicable depression and/or severe dysregulation of mood, which include repeated episodes of pronounced elation, in combination with other risk factors, such as a family history of bipolar disorder, may justify a raised level of concern.”

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