Table 2.
Percentages of initial prodromes in patients with type I and II BD.
| BD I | BD II | BD I and IIa | ||||
|---|---|---|---|---|---|---|
| Name of the prodrome | Mania | Depression | Hypomania | Depression | Mania/hypomania | Depression |
| Overly talkative | 53.1%b | 3.1%b | 27.3%b | 46.5–76.2%b,c,d | 3.7–4.8%b,d | |
| Racing thoughtse | 46.9%b | 6.3%b | 36.4%b | 44.2–75.0%b,c ,d | 4.8–7.4%b,d | |
| Irritabilityf | 43.8%b | 28.1%b | 36.4%b | 45.5%b | 41.9–67.0%b,c,d | 19.0–51.8%b,d |
| Mood elevationg | 37.5%b | 18.2%b | 9.1%b | 32.6–77.0%b,c,d | 3.7%b | |
| Mood lability/Mood swings | 33.3–56.3%b,h | 9.4–66.6%b,h | 36.4%b | 27.3%b | 26.2–51.2%b,d | 22.2–31.0%b,d |
| Reckless or dangerous behavior | 9.4%b | 3.1%b | 7.0–57.0%b,c,d | 2.4–3.7%b,d | ||
| Impatience | 53.1% b | 18.8% b | 36.4% b | 9.1% b | 48.8–57.1% b , d | 21.4–25.9% b , d |
| Insomnia i | 53.1% b | 15.6% b | 36.4% b | 11.6–54.8% b , d | 22.7–82.0% b , c , d | |
| Physically agitated | 50.0% b | 15.6% b | 27.3% b | 44.2–78.6% b , d | ||
| Depressed mood | 46.9% b | 28.1% b | 54.5% b | 36.4% b | 2.4–48.8% b , d | 48.1–83.0% b , c , d |
| Increased energy or goal-directed activity | 46.9% b | 18.2% b | 39.5–73.0% b , c | |||
| Anxiety | 43.8% b | 25.0% b | 45.5% b | 27.3% b | 31.0–44.2% b , d | 40.7–64.3% b , d |
| Tiredness or lack of energy | 37.5% b | 28.1% b | 27.3% b | 45.5% b | 9.5–34.9% b , d | 51.8–76.2% b , c , d |
| Social isolation | 28.1% b | 25.0% b | 36.4% b | 7.1–25.3% b , d | 44.4–69.0% b , d | |
| Decreased school or work functioning | 25.0% b | 18.8% b | 18.2% b | 9.1% b | 14.3–23.3% b , d | 25.9–69.0% b , c , d |
| Decreased need for sleep | 25.0% b | 3.1% b | 27.3% b | 9.1% b | 71.4% d | |
| Overly self-confident | 21.9% b | 18.2% b | 9.1% b | 20.9–69.0% b , d | 2.4–3.7% b , d | |
| Feeling worthless or guilty | 21.9% b | 6.3% b | 18.2% b | 36.4% b | 4.8–20.9% b , d | 22.2–79.0% b , c , d |
| Suspiciousness | 21.9% b | 9.4% b | 18.2% b | 9.1% b | 16.7–20.9% b , d | 14.8–23.8% b , d |
| Weight loss or decrease in appetite | 18.8% b | 3.1% b | 9.1% b | 9.1% b | 20.9–28.6% b , d | 7.4–40.5% b , d |
| Difficulty making decisions | 18.8% b | 6.3% b | 36.4% b | 27.3% b | 11.9–23.3% b , d | 18.5–61.9% b , d |
| Inversion of the sleep/wakefulness pattern | 18.8% b | 6.3% b | 14.0–78.0% b , c | 7.4% b | ||
| Overly creative | 15.6% b | 18.2% b | 9.1% b | 16.3–54.8% b , d | 3.7–9.5% b , d | |
| Defiant behavior | 15.6% b | 3.1% b | 9.1% b | 9.1% b | 14.0–35.7% b , d | 2.4–7.4% b , d |
| Thinking about suicide | 12.5% b | 12.5% b | 9.1% b | 7.1–11.6% b , d | 14.8–70.0% b , c , d | |
| Obsessions or compulsions j | 12.5% b | 9.1% b | 2.4–11.6% b , d | 7.1% d | ||
| Increased sexual energy | 12.5% b | 9.1% b | 11.6–31.0% b , d | 2.4% d | ||
| Weight gain or increase in appetite | 9.4% b | 9.4% b | 9.1% b | 18.2% b | 4.8–34.9% b , d | 21.4–22.7% b , d |
| Hypersomnia | 6.3% b | 12.5% b | 9.1% b | 18.2% b | 7.0–7.1% b , d | 22.7–33.3% b , d |
| Hallucinatory experiences | 6.3% b | 6.3% b | 4.7–4.8% b , d | |||
| Self-harming behavior | 3.1% b | 2.3–4.8% b , d | 4.8% d | |||
| Risky sexual behavior | 3.1% b | 2.3–19.0% b , d | ||||
| Strange or unusual ideas | 9.1% b | 2.3–19.0% b , d | 4.8% d | |||
| Decreased concentration | 37.5% b | 12.5% b | 36.4% b | 36.4% b | 37.2% b | 29.6% b |
| Overly cheerful | 37.5% b | 3.1% b | 9.1% b | 9.1% b | 30.2% b | 7.4% b |
| Anhedonia | 31.3% b | 9.4% b | 36.4% b | 27.3% b | 44.2% b | 22.2–72.0% b , c |
| Difficulty thinking or communicating clearly | 18.8% b | 12.5% b | 9.1% b | 9.1% b | 16.3% b | 18.5% b |
| Physically slowed down | 9.4% b | 18.8% b | 18.2% b | 27.3% b | 11.6% b | 33.3% b |
| Extremely energetic/active | 85.7% d | 4.8% d | ||||
| Poor judgment | 72.0% c | |||||
| Disturbed diurnal rhythm | 47.6% d | 31.0% d | ||||
| Lack of concentration | 35.7% d | 59.5–76.0% c , d | ||||
| Thought disorder | 26.2% d | 45.2% d | ||||
| Immature behavior | 26.2% d | 2.4% d | ||||
| Physical exhaustion | 11.9% d | 78.6% d | ||||
| Reduce vitality | 81.0% d | |||||
| Suicide attempts | 2.4% d | |||||
a
The studies did not distinguish prodromes by type of BD.
b
Noto et al. [36].
c
Hirschfeld et al. [33].
d
Zeschel et al. [38].
e
Racing thoughts/increased speech in Hirschfeld et al. [33].
f
Excessive irritability/aggressive behavior in Hirschfeld et al. [33].
g
Heightened mood/elation in Hirschfeld et al. [33].
h
Özgürdal et al. [37].
i
Insomnia/excessive sleep in Hirschfeld et al. [33].
j
Only compulsions in Zeschel et al. [38].