Identification and management of prodromal symptoms in bipolar affective disorder: the role of individual, disorder, and treatment-related factors.

Abstract

Background: Traditional psychosocial treatments have been adapted for use with individuals with bipolar affective disorders due to the limited prophylactic nature of pharmacotherapy and the recognition of the role of psychosocial factors in the course of this disorder. Psychosocial interventions that include a prodromal monitoring and management component have been empirically shown to be an effective adjunct to medication for the treatment of bipolar disorder. Aims: There is a deficit of quantitative research that examines the impact of individualrelated (e.g. age, self-efficacy), disorder-related (e.g. time since diagnosis, experience of prodromal symptoms) and treatment-related (e.g. level of psychosocial input) factors on individuals’ ability to manage this disorder via the use of prodromal monitoring. The current research aimed to investigate factors that are associated with the identification and management of prodromal symptoms. Method: Participants completed five self-report measures in order to provide information on their experience of prodromal symptoms, current mood state, general self-efficacy, view of social support from significant others, and demographic and clinical-related variables. The data were collected from 101 participants, 58 of whom were female. The sample consisted of individuals with a diagnosis of bipolar disorder type I and II. Results: Univariate and bivariate analyses were used to explore the relationship between individual, disorder, and treatment-related variables associated with participants’ experience of bipolar disorder. Variables that were significantly associated with participants’ perception of their ability to identify and manage prodromes were further investigated using ordinal logistic regression analyses. The results indicated that general self-efficacy and prodromal-specific help from significant others were associated with an increase in participants’ perception of their ability to identify manic and depressive prodromal symptoms. General self-efficacy was also associated with participants’ view of their ability to manage cognitive and behavioural prodromes. Experience of prodromal symptoms (e.g. consistency of symptoms experienced, type of prodrome experienced) was associated the participants’ perception of their ability to identify and manage prodromes. In general, disorder-related variables (e.g. time since diagnosis, mood state, diagnosis type, and number of episodes experienced) were not significantly associated with the participants’ view of their ability to identify and manage prodromal symptoms. Individual-related variables such as gender and age, however, were associated with prodromal identification. Conclusion: The results indicated the need to consider constructs such as general selfefficacy and experience of prodromal symptoms (e.g. consistency of symptoms, types of prodromes experienced, and ability to recognise prodromes when they first present) when helping patients to learn how to identify and manage prodromal symptoms. In addition gender differences and the role of help from significant others were highlighted as variables that should be considered when using prodromal monitoring approaches with patients with bipolar disorder. Limitations of the research are reviewed in relation to the methodology used. Clinical implications and directions for future research are considered.