Can early symptoms predict bipolar disorder? Evidence shows differing patterns of risk factorsJanuary 12, 2018
January 12, 2018 - Two patterns of antecedent or "prodromal" psychiatric symptoms may help to identify young persons at increased risk of developing bipolar disorder (BD), according to a new analysis in the Harvard Review of Psychiatry. The journal is published by Wolters Kluwer.
Early signs of BD can fall into a relatively characteristic "homotypic" pattern, consisting mainly of symptoms or other features associated with mood disorders; or a "heterotypic" pattern of other symptoms including anxiety and disruptive behavior. Environmental risk factors and exposures can also contribute to BD risk, according to the analysis by Ciro Marangoni, MD, at the Department of Mental Health, Mater Salutis Hospital, Legnato, Italy; Gianni L. Faedda, MD, Director of the Mood Disorder Center of New York, NY, and Co-Chairman of a Task Force of the International Society for Bipolar Disorders on this topic; and Professor Ross J. Baldessarini, MD, Director of the International Consortium for Bipolar & Psychotic Disorders Research of the Mailman Research Center at McLean Hospital in Belmont, Mass.
Different Symptom Patterns, Differing Implications for BD Risk
The authors reviewed and analyzed data from 39 studies of prodromal symptoms and risk factors for later development of BD. Their analysis focused on high-quality evidence from prospective studies in which data on early symptoms and risk factors were gathered before BD was diagnosed.
BD is commonly preceded by early depression or other symptoms of mental illness, sometimes years before BD develops, as indicated by onset of mania or hypomania. Nevertheless, the authors note that "the prodromal phase of BD remains incompletely characterized, limiting early detection of BD and delaying interventions that might limit future morbidity."
The evidence reviewed suggested two patterns of early symptoms that "precede and predict" later BD. A homotypic pattern consisted of affective or mood-associated symptoms that are related to, but fall short of, standard diagnostic criteria for BD: for example, mood swings, relatively mild symptoms of excitement, or major depression, sometimes severe and with psychotic symptoms.
The authors note that homotypic symptoms have "low sensitivity"--that is, most young people with these mood symptoms do not later develop BD. However, this symptom pattern also had "moderate to high specificity"--homotypic symptoms do occur in many patients who go on to develop BD.
The heterotypic pattern consisted of other types of prodromal symptoms, such as early anxiety and disorders of attention or behavior. This pattern had low sensitivity and specificity: relatively few patients with such symptoms develop BD, while many young people without heterotopic symptoms do develop BD.
The study findings also associate several other factors with an increased risk of developing BD, including preterm birth, head injury, drug exposures (especially cocaine), physical or sexual abuse, and other forms of stress. However, for most of these risk factors, both sensitivity and specificity are low.
Although many elements of the reported patterns of prodromal symptoms and risk factors have been identified previously, the study increases confidence that they are related to the later occurrence of BD. The researchers note that the findings of high-quality data from prospective studies are "encouragingly similar" to those of previous retrospective and family-risk studies.
"There was evidence of a wide range of [psychiatric] symptoms, behavioral changes, and exposures with statistically significant associations with later diagnoses of BD," the authors conclude. With further study, the patterns of prodromal symptoms and risk factors may lead to new approaches to identifying young persons who are likely to develop BD, and might benefit from early treatment. The investigators add that predictive value might be even higher with combinations of multiple risk factors, rather than single predictors.
About the Harvard Review of Psychiatry
The Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass major issues in contemporary psychiatry, including neuroscience, epidemiology, psychopharmacology, psychotherapy, history of psychiatry, and ethics.
About Wolters Kluwer
Wolters Kluwer N.V. (AEX: WKL) is a global leader in information services and solutions for professionals in the health, tax and accounting, risk and compliance, finance and legal sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.
Wolters Kluwer reported 2016 annual revenues of €4.3 billion. The company, headquartered in Alphen aan den Rijn, the Netherlands, serves customers in over 180 countries, maintains operations in over 40 countries and employs 19,000 people worldwide.
Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and the organization, visit http://www.wolterskluwer.com/, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.
For more information about Wolters Kluwer's solutions and organization, visit http://www.wolterskluwer.com, follow us on Twitter, Facebook, LinkedIn, and YouTube.
Wolters Kluwer Health
Related Mental Health Articles:
Food insecurity (FI) affects nearly 795 million people worldwide. Although a complex phenomenon encompassing food availability, affordability, utilization, and even the social norms that define acceptable ways to acquire food, FI can affect people's health beyond its impact on nutrition.
When people think about climate change, they probably think first about its effects on the environment, and possibly on their physical health.
The BioScience Talks podcast features discussions of topical issues related to the biological sciences.
Men who see themselves as playboys or as having power over women are more likely to have psychological problems than men who conform less to traditionally masculine norms, according to research published by the American Psychological Association.
UCSB researchers study the effectiveness of an innovative program designed to help youth learn about mental health.
Engaging the brain's dorsolateral prefrontal cortex (DL-PFC) while doing mental math may be connected with better emotional health, according to Duke researchers.
A new graduate education program at the University of Missouri has received nearly $700,000 from the Health Resources and Services Administration in the US Department of Health and Human Services to train psychology doctoral candidates in integrated, primary health care settings, in an effort to improve health care for underserved populations with mental health and physical disorders.
The loss of private health insurance from an employer can lead to poorer mental and physical health as older adults transition to early retirement, according to a study by Georgia State University.
Here's another reason to start saving for that beach house: new research suggests that residents with a view of the water are less stressed.
This study compares information available in a typical electronic health record (EHR) with data from insurance claims, focusing on diagnoses, visits, and hospital care for depression and bipolar disorder.
Related Mental Health Reading:
Mental Health: Personalities: Personality Disorders, Mental Disorders & Psychotic Disorders
by Carol Franklin (Author)
At some point in your life you will probably start to think you are losing your mind, or that someone you know is in danger of losing theirs. The truth is that modern life is extremely stressful; there are many demands on your time and never enough hours in the day.
However, being at the end of your tether, worn out and overwhelmed is not the same as having a mental disorder. In fact mental health covers a wide range of illnesses including those which most people are aware of, such as Schizophrenia (which is classed as a psychotic disorder). What you may not be... View Details
No One Cares About Crazy People: The Chaos and Heartbreak of Mental Health in America
by Ron Powers (Author)
* Finalist for the PEN/E. O. Wilson Literary Science Writing Award * Washington Post Notable Book of the Year * People Magazine Best Book of the Year * Shelf Awareness Best Book of the Year *
"Extraordinary and courageous . . . No doubt if everyone were to read this book, the world would change."---New York Times Book Review
New York Times-bestselling author Ron Powers offers a searching, richly researched narrative of the social history of mental illness in America paired with the deeply personal story of his two sons' battles with... View Details
All the Things We Never Knew: Chasing the Chaos of Mental Illness
by Sheila Hamilton (Author)
"A boldly beautiful page-turner about loving and losing someone with mental illness. I’ll be recommending this absorbing memoir for years to come." Cheryl Strayed, best-selling author of Wild
Even as a reporter, Sheila Hamilton missed the signs as her husband David’s mental illness unfolded before her. By the time she had pieced together the puzzle, it was too late. Her once brilliant and passionate partner was dead within six weeks of a diagnosis of bipolar disorder, leaving his young daughter and wife without so much as a note to explain his actions, a plan to... View Details
Better Days - A Mental Health Recovery Workbook
by Craig Lewis (Author)
This book helps those aspiring toward recovery and wellness and also those in recovery, because it addresses and challenges the individual - in very real, basic and honest ways - to make significant cognitive adjustments in how they live their lives. The beauty of this curriculum is that people like to do it and don't consider it a chore, a demand, or a requirement, because every page subtly encourages the individual to think in realistic and forward-moving ways. This allows them to feel good about doing the work. This book is for any person who struggles with their mental health and who... View Details
Varcarolis' Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 7e
by Margaret Jordan Halter PhD APRN (Author)
Using a practical clinical perspective, Varcarolis' Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 7th Edition provides a clear understanding of the often-intimidating subject of psychiatric mental health nursing. Clinical chapters follow the nursing process framework and progress from theory to application, preparing you for practice with real-world examples. New to this edition are the latest DSM-5 guidelines along with coverage of trauma, pediatric mental health, and QSEN competencies. From new lead author Dr. Margaret Jordan Halter, this... View Details
Psychiatric Mental Health Nursing: Concepts of Care in Evidence-Based Practice
by Mary C. Townsend DSN PMHCNS-BC (Author)
Rely on the distinctive voice and dedicated vision of Mary C. Townsend to provide the most clearly written, comprehensive text for psychiatric mental health nursing. Its evidence-based, holistic approach to nursing practice focuses on both biological and behavioral components.
The 8th Edition of this popular text delivers even more of what nursing students need to meet the challenges of health care today. Completely revised and updated throughout, it reflects all of the new knowledge in the field and the practice of mental health nursing today, including DSM-5,... View Details
Crazy: A Father's Search Through America's Mental Health Madness
by Pete Earley (Author)
Former Washington Post reporter Pete Earley had written extensively about the criminal justice system. But it was only when his own son-in the throes of a manic episode-broke into a neighbor's house that he learned what happens to mentally ill people who break a law.
This is the Earley family's compelling story, a troubling look at bureaucratic apathy and the countless thousands who suffer confinement instead of care, brutal conditions instead of treatment, in the "revolving doors" between hospital and jail. With mass deinstitutionalization, large numbers of state mental... View Details
Varcarolis' Foundations of Psychiatric-Mental Health Nursing: A Clinical Approach, 8e
by Margaret Jordan Halter PhD APRN (Author)
Varcarolis' Foundations of Psychiatric-Mental Health Nursing, 8th Edition is the most comprehensive RN psychiatric nursing text on the market! User-friendly by design, it simplifies the often-intimidating subject of psychiatric-mental health nursing with a practical, clinical perspective. This edition was revised in conjunction with a readability expert to support clarity and ease of understanding. Chapters follow the nursing process framework and progress from theory to application, preparing your students for clinical practice with real-world examples. New to this edition are... View Details
Psychiatric-Mental Health Nurse Practitioner Review and Resource Manual, 4th Edition
by Kathryn Johnson (Author), Dawn Vanderhoef (Author)
Written by experts in psychiatric-mental health nurse practitioner practice, this book provides a clinical reference tool and certification examination preparation. This manual helps readers enhance critical thinking skills and identify strengths and weaknesses. We are unable to accept returns for this manual. Please double-check your order before submitting. View Details
Mental Health Emergencies: A Guide to Recognizing and Handling Mental Health Crises
by Nick Benas (Author), Michele Hart (Author)
Ready reference to mental and emotional health crises and concerns, providing overviews and expert guidance on more serious problems. Ideal for first-responders, teachers, counselors, and human resource professionals.
Developed from best-practices of psychiatry, psychology and mental health counseling, Mental Health Emergencies is a guide to providing much-needed care and support to the people in distress who most need help including self-injury, eating disorders, substance abuse, psychosis, and suicidal thoughts.
Mental Health Emergencies will help... View Details