Clinical characteristic of prodromal symptoms between bipolar I and II disorder among Chinese patients: a retrospective study

Qian Zhao; Tong Guo; Yang Li; Lei Zhang; Nan Lyu; Amanda Wilson; Xuequan Zhu; Xiaohong Li

doi:10.1186/s12888-021-03295-y

Clinical characteristic of prodromal symptoms between bipolar I and II disorder among Chinese patients: a retrospective study

BMC Psychiatry. 2021 May 31;21(1):275. doi: 10.1186/s12888-021-03295-y.

Authors

Qian Zhao^#^{1

2}, Tong Guo^#¹, Yang Li^#¹, Lei Zhang¹, Nan Lyu¹, Amanda Wilson³, Xuequan Zhu^{1

2}, Xiaohong Li⁴

Affiliations

¹ The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
² Beijing Advanced Innovation Center for Big Data Based Precision Medicine, Beihang University, Beijing, China.
³ Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK.
⁴ The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China. lixiaohong_anding@ccmu.edu.cn.

^# Contributed equally.

Abstract

Background: This study aimed to identify the clinical characteristic of prodromal symptoms in Chinese patients with bipolar disorder (BD), prior to the first affective episode. It further aimed to characterize the prodromal traits between bipolar disorder type I (BD-I) and type II (BD-II).

Methods: 120 individuals with BD-I (n = 92) and BD- II (n = 28) were recruited to the study. Semi-structured interviews were then administered to evaluate prodromal symptoms in patients, within 3 years of BD onset, by using the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R).

Results: In the prodromal phase of the first depressive episode, patients with BD-II experienced more prodromal symptoms (p = 0.0028) compared to BD-I. Additionally, more frequent predictors were reported in patients with BD-II than BD-I including educational and occupational dysfunction (p = 0.0023), social isolation (p < 0.001), difficulty making decisions (p = 0.0012), oppositionality (p = 0.012), and suspiciousness/persecutory ideas (p = 0.017). There were also differences in the duration of the precursors. The duration of "weight loss or decrease in appetite" (p = 0.016) lasted longer in patients with BD-I, while "obsessions and compulsions" (p = 0.023) started earlier in patients with BD-II and occurred during the pre-depressive period. The prevalence and duration of each reported prodrome, preceding a first (hypo) manic episode, showed no difference between patients with BD-I and BD-II.

Conclusions: Specific affective, general, or psychotic symptoms occurred prior to both affective episodes. The characteristic of prodromal symptoms were key predictors for later episodes of BD including attenuated mania-like symptoms, subthreshold depressed mood, mood swings/lability, and anxiety. In the pre-depressive state, when compared to BD-II, BD-I presented with more prodromal symptoms in nonspecific dimensions, which indicated the substantial burden of BD-II. In conclusion, this study extends the understanding of the characteristics of prodromes of BD-I and BD-II.

Keywords: Bipolar I disorder; Bipolar II disorder; Depression; Early recognition; Mania; Prodromal symptoms.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Affective Symptoms
Bipolar Disorder* / diagnosis
China
Humans
Prodromal Symptoms*
Retrospective Studies