Bipolar disorder often manifests at an early age and all-to-often goes unrecognized for many years before it is diagnosed and appropriately treated. This can be especially difficult as patients with bipolar disorder often present with a depressive episode not easily distinguishable from unipolar depression. The International Society of Bipolar Disorders (ISBD) task force has recently published work attempting to identify some of the precursors and prodromes that may predict eventual diagnosis of bipolar disorder. The ISBD task force looked at several risk factors including homotypic symptoms (overlapping with bipolar disorder diagnostic criteria) and heterotypic symptoms (not overlapping with bipolar disorder diagnostic criteria), family history, and temperament. This research on existing retrospective and prospective studies found several factors that increase risk of eventual diagnosis of bipolar disorder (Figure), among which the presence of even subthreshold (hypo)manic symptoms was the most powerful predictor. Although no one single factor can predict a bipolar disorder diagnosis, in combination, such factors should alert the clinician that a patient may be at risk. These data further enforce the importance of screening all patients with depression, especially children and adolescents, for the presence of (hypo)manic symptoms and vigorously questioning patients and their caregivers about family history of bipolar disorder.
Figure: Precursors and Prodromes of Bipolar Disorder
Although no single factor can predict eventual diagnosis of bipolar disorder (and many of these factors may also be prodromal to other psychiatric disorders), collectively, the shown factors (especially (hypo)manic symptoms) may provide clues that a patient is at risk for a diagnosis of bipolar disorder.
Faedda GL et al. Bipolar Disord 2019; Epub ahead of print. Abstract
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