Journal of Affective Disorders
Volume 126, Issue 1 , Pages 1-13, October 2010

Symptoms and signs of the initial prodrome of bipolar disorder:

A systematic review

  • Dag V. Skjelstad

      Affiliations

    • Vestre Viken, Buskerud Hospital, Norway
    • Corresponding Author InformationCorresponding author. Vestre Viken, Buskerud Hospital, Division of Psychiatry, Unit of Mental Health Research and Development, P.O. Box 135, NO 3401-Lier, Norway. Tel.: +47 32 80 43 41 (direct line), +47 32804400 (operator); fax: +47 32804377.
    • ,
  • Ulrik F. Malt

      Affiliations

    • Oslo University Hospital, Rikshospitalet, Norway
    • University of Oslo, Institute of Psychiatry, Norway
    • ,
  • Arne Holte

      Affiliations

    • Norwegian Institute of Public Health, Division of Mental Health, Norway
    • University of Oslo, Institute of Psychology, Norway

Received 5 June 2009; received in revised form 7 October 2009; accepted 8 October 2009.

Abstract 

Background

Systematic studies addressing symptoms, signs and temporal aspects of initial bipolar prodrome are reviewed to identify potential clinical targets for early intervention.

Methods

The databases PsycINFO, PubMed, EMBASE and British Nursing Index were searched for original studies.

Results

Eight studies were identified. Irritability and aggressiveness, sleep disturbances, depression and mania symptoms/signs, hyperactivity, anxiety, and mood swings are clusters representing common symptoms and signs of the distal prodrome of bipolar disorder (BD). As time to full BD onset decreases, symptoms of mania and depression seem to increase gradually in strength and prevalence. The specificity of prodromal symptoms and signs appears to be low. Not every person who develops BD experiences a prolonged initial prodrome to the full illness. Current data on the mean duration of the prodrome are contradictory, ranging from 1.8 to 7.3years. No qualitative studies were found.

Limitations

Because of the scarcity of data, studies that did not explicitly investigate bipolar prodrome were included when thematically relevant. The selected studies are methodologically diverse and the validity of some findings is questionable. Findings must be interpreted cautiously.

Conclusions

The initial prodrome of BD is characterized by dysregulation of mood and energy. Because of the apparently low specificity of prodromal symptoms and signs of BD, it is currently neither possible nor advisable to predict the development of BD based solely on early phenomenology. More well-designed in-depth studies, including qualitative ones, are needed to characterize the initial bipolar prodrome.

Keywords: Bipolar disorder, Initial prodrome, Symptoms and signs, Review

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PII: S0165-0327(09)00463-7

doi:10.1016/j.jad.2009.10.003

Journal of Affective Disorders
Volume 126, Issue 1 , Pages 1-13, October 2010

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