Maassen Eva F, Maathuis Lotte, Regeer Barbara J, Kupka Ralph W, Regeer Eline J
Department Bipolar Disorders, Altrecht Institute for Mental Health Care, Lange Nieuwstraat 119, Utrecht, 3512 PG, The Netherlands.
Het Nederlandse Rode Kruis Verenigingskantoor, Anna van Saksenlaan 50, Den Haag, 2593 HT, The Netherlands.
Int J Bipolar Disord. 2024 Nov 14;12(1):38. doi: 10.1186/s40345-024-00360-9.
Diagnosing bipolar disorder (BD) is challenging, and adequate treatment is of major importance to minimalize the consequences of the illness. Early recognition is one way to address this. Although in clinical research the prodromal phase of BD is gaining interest, the perspective of patients with BD and their caregivers on prodromal symptoms is still lacking. The aim of this study is to gain insights in prodromal symptoms of patients with BD and their caregivers before the onset of a first manic episode.
A qualitative research method was used to investigate prodromal symptoms one year prior to a first manic episode. In-depth interviews were conducted with patients with BD type I and their caregivers. Only patients with a first manic episode in the previous five years were included.
The prodromal symptoms from patients' and caregivers' perspectives could be clustered into seven themes, with underlying subthemes: behavior (increased activity, destructive behavior, disinhibited behavior, inadequate behavior, changes in appearance), physical changes (changes in sleep, physical signals, differences in facial expression), communication (reciprocity, process, changes in use of social media), thought (process and content), cognition (changes in attention and concentration, forgetfulness), emotions (positive emotions, more intense emotions, mood swings), and personality (more pronounced manifestation of existing personality traits).
Patients with bipolar I disorder and their caregivers described subsyndromal manic features one year prior to a first manic episode. In addition, they recognized mood lability, physical changes and more pronounced manifestation of existing personality traits. The results of this study confirm the presence of a prodromal phase. In clinical practice, monitoring of prodromal symptoms of BD can be useful in patients with depression, especially those with a familial risk of BD.
双相情感障碍（BD）的诊断具有挑战性，充分治疗对于将该疾病的后果降至最低至关重要。早期识别是解决这一问题的一种方法。尽管在临床研究中，BD的前驱期越来越受到关注，但仍缺乏BD患者及其照顾者对前驱症状的看法。本研究的目的是深入了解BD患者及其照顾者在首次躁狂发作前的前驱症状。
采用定性研究方法调查首次躁狂发作前一年的前驱症状。对I型BD患者及其照顾者进行了深入访谈。仅纳入在过去五年中有首次躁狂发作的患者。
从前驱症状的角度来看，患者及其照顾者的前驱症状可分为七个主题，并具有潜在的子主题：行为（活动增加、破坏行为、行为脱抑制、行为不当、外貌变化）、身体变化（睡眠变化、身体信号、面部表情差异）、沟通（互动、过程、社交媒体使用变化）、思维（过程和内容）、认知（注意力和专注力变化、健忘）、情绪（积极情绪、情绪更强烈、情绪波动）和个性（现有个性特征的更明显表现）。
I型双相情感障碍患者及其照顾者描述了首次躁狂发作前一年的亚综合征躁狂特征。此外，他们认识到情绪不稳定、身体变化以及现有个性特征的更明显表现。本研究结果证实了前驱期的存在。在临床实践中，监测BD的前驱症状对抑郁症患者可能有用，尤其是那些有BD家族风险的患者。
