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J Clin Psychiatry. 2015 May;76(5):614-24. doi: 10.4088/JCP.13r08900.
To evaluate the presence of affective signs and symptoms as precursors of bipolar disorder in prospective studies, including assessment of their prevalence, duration, and predictive value.
We followed PRISMA guidelines to search PubMed, CINAHL, PsycINFO, EMBASE, SCOPUS, and ISI Web of Science databases to May 31, 2013, using the terms bipolar disorder AND (antecedent* OR predict* OR prodrom* OR prospect*) AND (diagnosis OR development). Hand searching of identified reports led to additional relevant references.
We included only English-language articles containing (1) prospective, longitudinal studies with at least 2 structured clinical assessments (intake and follow-up); (2) no previous DSM-III or DSM-IV diagnoses of bipolar I or bipolar II; and (3) diagnostic outcome of bipolar I or bipolar II. Studies of subjects at familial risk of bipolar disorder were excluded, as these have been reviewed elsewhere.
We tabulated details of study design, outcomes, precursors, and predictive value. Only studies reporting a positive predictive association were included.
In 26 published reports meeting selection criteria, methods varied widely in terms of design, duration of follow-up, ages, and populations investigated. Despite such heterogeneity in methods, findings were notably consistent. Precursors of bipolar disorder include mood lability, subsyndromal and major depression, subsyndromal hypomanic symptoms with or without major depression, cyclothymia and bipolar not otherwise specified, major depression with psychotic features, and other psychotic disorders. Bipolar disorder was also predicted by juvenile onset of major depression as well as frequency and loading of hypomanic or depressive symptoms.
Despite the limitations of published reports, prospectively identified precursors of bipolar disorder typically arose years prior to syndromal onset, often with significant early morbidity and disability. Prospectively identified precursors of bipolar disorder are generally consistent with findings in retrospective and family-risk studies. Combining precursors and other risk factors may increase predictive value, support earlier diagnosis, improve treatment, and limit disability in bipolar disorder.
在前瞻性研究中评估情感征象和症状作为双相障碍前驱期的存在，包括评估其患病率、持续时间和预测价值。
我们遵循 PRISMA 指南，于 2013 年 5 月 31 日以前，通过在 PubMed、CINAHL、PsycINFO、EMBASE、SCOPUS 和 ISI Web of Science 数据库中使用术语“双相障碍 AND（前驱、预测、先兆 OR 预期）AND（诊断 OR 发展）”进行搜索。对已识别报告的手工检索导致了其他相关参考文献。
我们仅纳入包含以下内容的英文文章：（1）前瞻性、纵向研究，至少有 2 次结构化临床评估（摄入和随访）；（2）无 DSM-III 或 DSM-IV 之前的双相 I 或双相 II 诊断；（3）双相 I 或双相 II 的诊断结果。排除了双相障碍家族风险人群的研究，因为这些研究已在其他地方进行了综述。
我们列出了研究设计、结局、前驱症状和预测价值的详细信息。仅纳入报告阳性预测关联的研究。
在符合选择标准的 26 份已发表报告中，方法在设计、随访时间、年龄和研究人群方面差异很大。尽管方法存在这种异质性，但研究结果明显一致。双相障碍的前驱症状包括情绪不稳定、亚综合征和重性抑郁、伴有或不伴有重性抑郁的亚综合征轻躁狂症状、环性心境和未特定的双相、有精神病特征的重性抑郁，以及其他精神病障碍。双相障碍还可由青少年期重性抑郁发病以及轻躁狂或抑郁症状的频率和负荷预测。
尽管发表报告存在局限性，但前瞻性确定的双相障碍前驱症状通常在综合征发病前多年出现，通常具有显著的早期发病率和残疾。前瞻性确定的双相障碍前驱症状通常与回顾性和家族风险研究的发现一致。将前驱症状和其他危险因素结合起来可能会提高预测价值、支持早期诊断、改善治疗，并限制双相障碍的残疾。
