Clinical characteristics and influence of childhood trauma on the prodrome of bipolar disorder

• Published in: Revista brasileira de psiquiatria Vol. 37; no. 4; pp. 280 - 288
• Main Authors: Noto, Mariane N, Noto, Cristiano, Caribé, André C, Miranda-Scippa, Ângela, Nunes, Sandra O, Chaves, Ana C, Amino, Denise, Grassi-Oliveira, Rodrigo, Correll, Christoph U, Brietzke, Elisa
• Format: Journal Article
• Language: English
• Published: Brazil Associação Brasileira de Psiquiatria 01-10-2015; Associação Brasileira de Psiquiatria (ABP)
• Subjects: Adult; Bipolar disorder; Bipolar Disorder - etiology; Bipolar Disorder - psychology; Child; Child Abuse - psychology; childhood maltreatment; depression; Depressive Disorder - psychology; early stages; Female; Humans; Late Onset Disorders - psychology; Male; mania; Prodromal Symptoms; prodrome; Psychiatric Status Rating Scales; PSYCHIATRY; Psychological Trauma - complications; Psychological Trauma - psychology; Psychometrics; Severity of Illness Index; Surveys and Questionnaires; Time Factors; Bipolar disorder; childhood maltreatment; depression; prodrome; early stages; mania
• ISSN: 1516-4446; 1809-452X; 1809-452X; 1516-4446
• DOI: 10.1590/1516-4446-2014-1641

To describe the onset pattern, frequency, and severity of the signs and symptoms of the prodrome of the first hypomanic/manic episode and first depressive episode of bipolar disorder (BD) and to investigate the influence of a history of childhood maltreatment on the expression of prodromal symptoms.
Using a semi-structured interview, the Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R), information regarding prodromal symptoms was assessed from patients with a DSM-IV diagnosis of BD. History of childhood maltreatment was evaluated using the Childhood Trauma Questionnaire (CTQ).
Forty-three individuals with stable BD were included. On average, the prodrome of mania lasted 35.8 ± 68.7 months and was predominantly subacute or insidious, with rare acute presentations. The prodrome of depression lasted 16.6 ± 23.3 months and was also predominantly subacute or insidious, with few acute presentations. The prodromal symptoms most frequently reported prior to the first hypomanic or manic episode were mood lability, depressive mood, and impatience. A history of childhood abuse and neglect was reported by 81.4% of participants. Presence of childhood maltreatment was positively associated with prodromal symptoms, including social withdrawal, decreased functioning, and anhedonia.
This study provides evidence of a long-lasting, symptomatic prodrome prior to first hypomanic/manic and depressive episode in BD and suggests that a history of childhood maltreatment influences the manifestations of this prodrome.