Malhi Gin S, Bargh Danielle M, Coulston Carissa M, Das Pritha, Berk Michael
Department of Psychiatry, CADE Clinic, Royal North Shore Hospital, Sydney, NSW, Australia; Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Bipolar Disord. 2014 Aug;16(5):455-70. doi: 10.1111/bdi.12133. Epub 2013 Oct 25.
Bipolar disorder is a multifaceted illness and there is often a substantial delay between the first onset of symptoms and diagnosis. Early detection has the potential to curtail illness progression and disorder-associated burden but it requires a clear understanding of the initial bipolar prodrome. This article summarizes the phenomenology of bipolar disorder with an emphasis on the initial prodrome, the evolution of the illness, and the implications for prevention and early intervention.
A literature review was undertaken using Medline, Web of Science, and a hand search of relevant literature using keywords (e.g., phenomenology, initial or early symptoms, risk factors, and predictors/prediction). Findings from the literature were reviewed and synthesized and have been put into a clinical context.
Bipolar disorder is a recurrent, persistent, and disabling illness that typically develops in adolescence or early adulthood. The literature search yielded 28 articles, in which mood lability, nonspecific, non-mood symptoms, and cyclothymic temperament were the most cited prodromal features.
A small number of key prospective studies have provided evidence in support of an initial bipolar prodrome; however, methodological differences across studies have prohibited its clear delineation. It is, therefore, not currently possible to anticipate those who will develop bipolar disorder solely on the basis of early phenomenology. Accurate characterization of the bipolar disorder prodrome through high-quality, prospective research studies with adequate control groups will ultimately facilitate prompt and accurate diagnosis.
双相情感障碍是一种多方面的疾病，症状首次出现与诊断之间往往存在相当长的延迟。早期发现有可能遏制疾病进展和与疾病相关的负担，但这需要对双相情感障碍最初的前驱症状有清晰的认识。本文总结了双相情感障碍的现象学，重点关注最初的前驱症状、疾病的演变以及对预防和早期干预的意义。
使用Medline、科学网进行文献综述，并通过关键词（如现象学、初始或早期症状、危险因素以及预测因素/预测）手工检索相关文献。对文献中的研究结果进行了综述和综合，并将其置于临床背景中。
双相情感障碍是一种复发性、持续性且致残的疾病，通常在青少年期或成年早期发病。文献检索得到28篇文章，其中情绪不稳定、非特异性非情绪症状和环性心境气质是被引用最多的前驱特征。
少数关键的前瞻性研究提供了支持双相情感障碍存在初始前驱症状的证据；然而，各研究之间的方法学差异阻碍了对其进行清晰的界定。因此，目前仅根据早期现象学无法预测哪些人会患上双相情感障碍。通过高质量、有足够对照组的前瞻性研究准确描述双相情感障碍的前驱症状，最终将有助于及时、准确的诊断。
