Mood Disorders Center, New York, NY, USA.
International Consortium for Mood and Psychotic Disorders Research, McLean Hospital, Belmont, MA, USA.
Bipolar Disord. 2019 Dec;21(8):720-740. doi: 10.1111/bdi.12831. Epub 2019 Sep 18.
To clarify the clinical features preceding the onset of bipolar disorder (BD) has become a public health priority for the prevention of high morbidity and mortality. BD remains frequently under- or misdiagnosed, and under- or mistreated, often for years.
We assessed the predictive value of precursors and prodromes of BD. We assessed precursors of first-lifetime manic or hypomanic episodes with/without mixed features in retrospective and prospective studies. The task force evaluated and summarized separately assessments of familial risk, premorbid personality traits, retrospective, and prospective studies.
Cyclothymic features, a family history of BD, retrospectively reported attenuated manic symptoms, prospectively identified subthreshold symptoms of hypomania, recurrence of depression, panic anxiety and psychotic features, have been identified as clinical precursors of BD. The prodromal symptoms like [hypo]mania often appears to be long enough to encourage early identification and timely intervention.
The predictive value of any risk factor identified remains largely unknown. Prospective controlled studies are urgently needed for prevention and effective treatment.
阐明双相障碍（BD）发病前的临床特征已成为预防高发病率和高死亡率的公共卫生重点。BD 仍然经常被漏诊或误诊，而且治疗不足，往往持续多年。
我们评估了 BD 的前驱期和前驱症状的预测价值。我们在回顾性和前瞻性研究中评估了首发躁狂或轻躁狂发作伴有/不伴有混合特征的前驱期。专家组分别评估了家族风险、发病前人格特征、回顾性和前瞻性研究。
环性特征、BD 的家族史、回顾性报告的轻躁狂症状减轻、前瞻性识别的阈下轻躁狂症状、抑郁复发、惊恐焦虑和精神病特征已被确定为 BD 的临床前驱期。前驱症状如[轻]躁狂症似乎持续时间足够长，可以鼓励早期识别和及时干预。
任何已确定的风险因素的预测价值仍知之甚少。迫切需要进行前瞻性对照研究以进行预防和有效治疗。
