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28-07-2010 | Mental health | Article

Clinical characteristics of prodrome to a first episode of mania identified


Free abstract

MedWire News: Researchers have identified several clinical characteristics that could help predict the onset of a first episode of psychotic mania in patients who have risk factors for or are vulnerable to bipolar disorder.

"Before onset of a first episode of psychotic mania, patients go through a phase of change from previous mental state, suggesting indicated prevention strategies could be applied if this prodromal phase was better defined," note Philippe Conus, from Université Lausanne in Switzerland, and colleagues.

To determine what factors might characterize this prodromal phase, the team measured risk factors and markers of vulnerability in 22 participants of a large first-episode psychotic mania cohort study started in 2001, when patients aged 15 to 29 experiencing a first episode of psychosis were enrolled.

They also used the General Behavior Inventory (GBI) and the Initial Mania Prodrome Questionnaire (IMPQ) to retrospectively assess clinical characteristics of the patients in the 12 months before the emergence of mania. The average duration of the prodrome period for the patients was 20.9 weeks.

As reported in the Journal of Affective Disorders, the researchers identified phenomenological manifestations experienced by more than 50% of patients during the 12 months preceding mania onset that could be grouped into three categories: mood symptoms, sleep changes, and behavioral or other symptoms.

Specifically, with regard to mood, 50% of patients displayed progressive development of attenuated manic symptoms culminating into mania, 30% first developed depressive symptoms and then attenuated manic symptoms culminating into mania, while 18% developed attenuated manic symptoms and then went through a phase of successive depressive and hypomanic stages before developing into full-blown mania.

Sleep changes comprised primarily disrupted sleep and reduced sleep or need for sleep, occurring in 83.3% and 61.1% of patients, respectively.

General behavioral symptoms commonly seen during the prodrome phase included increased stress, impaired functioning, and concentration problems.

The researchers note, however, that these factors globally are likely to have low specificity, saying: "Early identification of patients at risk to develop a first episode of psychotic mania is unlikely to be possible in the basis of symptoms alone."

However, they also noted some risk factors and vulnerability makers that were relatively common in the patients, and which in addition to these clinical symptoms could signal impending first-episode mania.

The risk factors included family history of affective disorder or past as well as recent exposure to a traumatic event, while the vulnerability markers were developmental delay, cyclothymic traits, previous depressive episodes, and recent increase in levels of substance use.

Conus et al point out that as their study involved a small number of patients and was retrospective, their findings need to be validated in larger prospective studies.

"Nevertheless, this study was conducted mainly in order to generate hypotheses... and as such... the uniqueness of the sample and the comprehensive multi-method and multi-formant assessment undertaken are likely to offer an important complement to the existing literature," they conclude.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Lucy Piper

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