2.3. Measures
Demographic and clinical information including age,
gender, living conditions, number of previous (hypo)manic
and depressive episodes, number of hospitalizations and
treatment history was gathered via a self-constructed
questionnaire. Current mood state was assessed using a
Visual Analogue Scale (VAS) ranging from 0 (severely
depressed) via 50 (euthymic) to 100 (severely manic).
During the interview patients were asked to answer the
following questions: ‘‘How can you tell if an episode of
mania or depression is impending?’’, and: ‘‘what is the first
sign or behaviour that you recognise in yourself that leads
up to a manic or depressive episode?’’
When the patient reported more than one sign or
behaviour the patient was asked to identify the very first
sign or behaviour usually experienced as a first step in
the recurrence process. Notes were taken during the
interview. To analyze these data an instrument was
inductively constructed to categorise the prodromal
symptoms of mania or depression. All prodromes of
mania and depression in bipolar disorder that have been
reported in the literature were listed. This list was sent
out to a psychiatrist and two specialized clinical nurses
working intensively with patients with bipolar disorder.
They were separately asked to cluster the prodromal
symptoms of manic or depressive recurrence from this
list into categories and put a label on each category.
Subsequently, the results of this clustering were discussed
and finalized during a consensus meeting (Table
1). Then, the prodromal symptoms of mania and
depression as reported by the respondents were classi-
fied in one of these categories.