Is it possible to prevent a bipolar patient’s first episode of mania before it even happens?
According to new research, there may be certain signs present before development of psychotic mania, that, when present in a high risk individual, might be able to predict the development of mania.
“Before onset of a first episode of psychotic mania, patients go through a phase of change from previous mental state where they present mood symptoms, sleep disruption and general functional decline,” says Philippe Conus, from Université Lausanne in Switzerland, who conducted the research with his colleagues.
Bipolar disorder is a psychiatric condition characterized by alternating periods of depression (low mood) and mania, or hypomania (a milder form of mania). Mania is diagnosed when three of more of the following symptoms are present; an elevated, agitated, or irritable mood, a decreased need for sleep, an increased need to talk, racing thoughts or lots of ideas, abnormally high self-esteem, difficulty focusing attention, an increased in goal-directed activity or difficulty sitting still, and reckless involvement in pleasurable activities (like sexual indiscretions, or excessive spending). Sometimes people with mania can also experience psychosis, a condition in which one has delusions (mistaken beliefs), hallucinations, and temporarily loses contact with reality.
To attempt to discern signs of a first episode of psychotic mania before it occurs, Conus and his colleagues enrolled 22 patients between the ages of 15 and 29 who had experienced their first episode of psychotic mania.
They reviewed each participant’s psychiatric history, and used the General Behavior Inventory (GBI) and the Initial Mania Prodrome Questionnaire (IMPQ), to assess the presence of possible psychiatric symptoms in the year before the manic episode.
They found that there was a prodrome (a period of time before the episode with subtle symptoms), in more than half of the study participants, and the average duration of the prodrome was 20.9 weeks.
During the period of time before their manic episode, the participants experienced a change from their prior mental health, including symptoms such as mood changes, changes in sleep pattern, and overall decline in general function (increased stress, impaired functioning, and concentration problems).
“Early identification of patients at risk to develop a first episode of psychotic mania is unlikely to be possible in the basis of symptoms alone,” says Conus.
However, although these symptoms are not specific enough to be of use in the general population, in individuals known to be at high risk for bipolar disorder, such symptoms may be of more significance. Some people at high risk include children of parents with bipolar or other mood disorders, those who have had or witnessed a traumatic event, those with developmental delay, those with cyclothymic traits, who have had previous depressive episodes, and who have had recent increase in levels of substance use.
Bipolar disorder affects more than 5 million Americans, according to the National Institute of Mental Health, and is the sixth leading cause of disability, according to the World Health Organization.
The average age of diagnosis of bipolar disorder is 25 years, but there is an increasing awareness of the presence of symptoms in children. The disorder can often be difficult to diagnosis in young people. There have been a number of research studies that show that repeated episodes of mania can increase the severity of the illness, make symptoms more difficult to control, and increase disease-related disability.
Future studies involving larger populations may help to identify additional risk factors, or other prodromal symptoms. Furthermore, additional research may help to determine what, if any, interventions may prevent or ameliorate the development of manic symptoms. “Prevention strategies could be applied if this prodromal phase was better defined,” concludes Philippe Conus, from Université Lausanne in Switzerland, and colleagues.
Dr. Conus’s results can be found in the August edition of the Journal of Affective Disorders.