Early warning signs detected by half of BD patients

Sep 20 2012

By Mark Cowen, Senior medwireNews Reporter

Almost half of patients with bipolar disorder (BD) are able to recognize early warning signs of a mood episode, Australian researchers report.

The team also found that BD patients were more likely to report recognizing early warning signs for both depression and mania/hypomania than either alone, suggesting that the ability to notice signs is not predominantly associated with a particular type of episode.

Factors associated with the ability to detect early signs of mood episodes included younger age, a greater number of previous episodes, and a history of visual hallucinations during previous episodes.

"These findings may assist clinicians in identifying patient groups who are likely to be poor at detecting early warning signs of illness episodes," say Tania Perich and colleagues from the University of New South Wales in Sydney.

"It may be useful to target psychoeducation programs particularly at these groups," they add.

The team studied 180 adults (mean age 39.5 years) with BD I or II who completed a psychiatric interview that included questions on illness course and the recognition of early warning signs of an impending mood episode.

In total, 85 (47%) reported recognizing warning signs while 95 (53%) did not.

A significantly greater number of participants reported recognizing early signs of both mania/hypomania and depression (n=35) than either manic/hypomanic (n=30) or depressive (n=20) warning signs alone.

The most frequently reported early sign of mania/hypomania was decreased sleep, and the most frequently reported early sign of depression was difficulty in thinking clearly, or negative thinking.

Although most psychotic symptoms were not associated with the ability to detect early warning signs, patients with visual hallucinations (n=59) were significantly more likely to report recognizing early warning signs for mania/hypomania than those without (49 vs 31%).

And patients with a history of mixed mood episodes were more likely to recognize early signs of depression than those without (50 vs 25%).

Furthermore, participants who reported detecting early warning signs of depression had a significantly greater number of depressive episodes (32.0 vs 16.3), and were younger at assessment (35.4 vs 41.1 years), at the time of the first manic/hypomanic episode (22.5 vs 26.5 years), and at the time of the first depressive episode (17.7 vs 21.9 years) than those who did not.

Participants who reported detecting mania/hypomania early warning signs were also younger at assessment, at first manic/hypomanic episode, and at first depressive episode than those who did not.

Perich et al conclude: "Longitudinal studies are required to explore how the ability to detect early warning signs may be associated with illness course."

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