Background: There is some evidence that teaching patients to recognise prodromes of
manic and depressive episodes improved time to recurrence and hospitalization, social
function, and performance in employment. Little information is available about which
prodromal symptom patients with bipolar disorder recognise as being the very first
symptom of recurrence.
Objectives: The aims of this study were to describe the very first symptoms in manic or
depressive recurrence reported by patients with bipolar disorder and to explore
associations between the ability to recognise these prodromal symptoms and the clinical
characteristics of these patients.
Design: A cross-sectional, descriptive design.
Settings: Five psychiatric outpatient clinics in the Netherlands.
Participants: 111 outpatients diagnosed with bipolar disorder, currently not in an episode.
Methods: Data were obtained through a face-to-face interview with open ended questions
and a questionnaire for demographic and clinical characteristics. Reported prodromes
were categorised in an instrument inductively constructed and based on literature review
and expert opinion. Associations were calculated with chi squares.
Results: The first recognised symptom of recurrence in mania was change in energy level
(21%), sleep (17%), and social functioning (16%). In depression it was change in thought (15%),
mood stability (12%), energy level (12%), social functioning (11%), and sleep (10%). Twentyeight
percent of the patients were not able to recognise prodromes of recurrence in mania.
Also 28% was not able to recognise prodromes of depression, and 12% was not able to
recognise either of them. A significant association (p = 0.033) was found between the ability
to recognise prodromes of depression and the lifetime number of depressive episodes.
Conclusions: The majority of euthymic patients with bipolar disorder are able to recognise
prodromes of recurrence. These warning signs often emerge early in the process of
recurrence. Our results suggest that patients learn to recognise prodromes of recurrence
rather by experience than from therapeutic interventions. Talking to patients and their
relatives closely after recovered from an episode to construct the early phase of recurrence
can be important to improve recognition and prevent future episodes ofmania or depression
Background: There is some evidence that teaching patients to recognise prodromes ofmanic and depressive episodes improved time to recurrence and hospitalization, socialfunction, and performance in employment. Little information is available about whichprodromal symptom patients with bipolar disorder recognise as being the very firstsymptom of recurrence.Objectives: The aims of this study were to describe the very first symptoms in manic ordepressive recurrence reported by patients with bipolar disorder and to exploreassociations between the ability to recognise these prodromal symptoms and the clinicalcharacteristics of these patients.Design: A cross-sectional, descriptive design.Settings: Five psychiatric outpatient clinics in the Netherlands.Participants: 111 outpatients diagnosed with bipolar disorder, currently not in an episode.Methods: Data were obtained through a face-to-face interview with open ended questionsand a questionnaire for demographic and clinical characteristics. Reported prodromeswere categorised in an instrument inductively constructed and based on literature reviewand expert opinion. Associations were calculated with chi squares.Results: The first recognised symptom of recurrence in mania was change in energy level(21%), sleep (17%), and social functioning (16%). In depression it was change in thought (15%),mood stability (12%), energy level (12%), social functioning (11%), and sleep (10%). Twentyeightpercent of the patients were not able to recognise prodromes of recurrence in mania.Also 28% was not able to recognise prodromes of depression, and 12% was not able torecognise either of them. A significant association (p = 0.033) was found between the abilityto recognise prodromes of depression and the lifetime number of depressive episodes.Conclusions: The majority of euthymic patients with bipolar disorder are able to recogniseprodromes of recurrence. These warning signs often emerge early in the process ofrecurrence. Our results suggest that patients learn to recognise prodromes of recurrencerather by experience than from therapeutic interventions. Talking to patients and theirrelatives closely after recovered from an episode to construct the early phase of recurrencecan be important to improve recognition and prevent future episodes ofmania or depression
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