Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, LWL-Universitätsklinikum Bochum, Germany.
Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA.
J Affect Disord. 2013 Nov;151(2):551-560. doi: 10.1016/j.jad.2013.06.043. Epub 2013 Aug 8.
To assess the phenomenology and course of pre-(hypo)manic and pre-depressed prodromal symptoms, including mood swings, as precursors of bipolar disorder (BD) in a German multi-center study.
Semi-structured interviews [Bipolar Prodrome Symptom Scale-Retrospective (BPSS-R); Semi-structured Interview for Mood Swings] were administered to patients within 8 years of BD (BD I, BD II) onset.
Forty two outpatients were included (40.5% male, mean age 35.1±10.0 years, illness onset at 30.5±9.5 years). Feeling extremely energetic (85.7%), racing thoughts (78.6%), physical agitation (76.2%), overtalkativeness (71.4%), and low sleep requirement (71.4%) occurred most frequently prior to the first (hypo)manic episode, whereas depressed mood (83.0%), reduced vitality (81.0%), physical exhaustion (78.6%), tiredness (76.2%), and insomnia (66.7%) preceded pre-depressively. Mood lability (p=.006), odd ideas (p=.003) and the psychosis index score (p=.003) differed significantly in prevalence depending on the episodes' mood. Extremely energetic (p=.046), overtalkativeness (p<.001), and racing thoughts (p=.013) lasted significantly longer prior to depression. Neither severity nor frequency of prodromal symptoms differed significantly. Most of the symptoms emerged during the proximal prodromal phase. Links between mood swings and subsequent BD were found.
Symptoms were evaluated retrospectively with self-reporting tools in bipolar patients from academic treatment settings without comparison to clinical controls.
Not only specific depressive or manic but also general symptoms occurred prior to both affective episodes. The pre-depressive prodrome lasted longer than the pre-manic one, but severity and frequency did not differ significantly. Mood swings and disturbed diurnal rhythm occurred prior to both episodes as early signs of BD.
在德国多中心研究中，评估双相障碍（BD）前（低）躁狂和前驱抑郁前驱症状的现象学和病程，包括情绪波动，作为双相障碍的前兆。
对发病后 8 年内的患者进行半结构化访谈[双相前驱症状量表-回顾性（BPSS-R）；情绪波动半结构化访谈]。
共纳入 42 名门诊患者（40.5%为男性，平均年龄 35.1±10.0 岁，发病年龄为 30.5±9.5 岁）。极度精力充沛（85.7%）、思维奔逸（78.6%）、身体躁动（76.2%）、多话（71.4%）和低睡眠需求（71.4%）在前首次（低）躁狂发作前最常发生，而抑郁情绪（83.0%）、活力下降（81.0%）、身体疲惫（78.6%）、疲倦（76.2%）和失眠（66.7%）在前抑郁前发生。根据发作时的情绪，心境不稳（p=.006）、奇异观念（p=.003）和精神病指数评分（p=.003）的发生率存在显著差异。在抑郁前，极度精力充沛（p=.046）、多话（p<.001）和思维奔逸（p=.013）持续时间明显更长。前驱症状的严重程度和频率均无显著差异。大多数症状出现在近端前驱期。发现情绪波动与随后的双相障碍之间存在关联。
在来自学术治疗环境的双相患者中，使用自我报告工具回顾性评估症状，且未与临床对照进行比较。
不仅特定的抑郁或躁狂症状，而且一般症状在前两次发作前都会出现。前驱抑郁的持续时间长于前驱躁狂的持续时间，但严重程度和频率没有显著差异。情绪波动和昼夜节律紊乱在两次发作前都会出现，是双相障碍的早期迹象。
