SynthesisJournal of the American Academy of Child and Adolescent Psychiatry2016
The Bipolar Prodrome: Meta-Analysis of Symptom Prevalence Prior to Initial or Recurrent Mood Episodes.
Synthesis in Journal of the American Academy of Child and Adolescent Psychiatry, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 83 papers, 7 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
83 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Development and predictors of bipolar disorder in children and adolescents with depressive disorders: a systematic review, meta-analysis, and meta-regression.European psychiatry : the journal of the Association of European Psychiatrists · 2025Pooled it
- Orexin receptor antagonists in the treatment of insomnia associated with psychiatric disorders: a systematic review.Translational psychiatry · 2024Pooled it
- Differentiation between bipolar disorder and major depressive disorder in adolescents: from clinical to biological biomarkers.Frontiers in human neuroscience · 2023Pooled it
- Epigenetic signatures relating to disease-associated genotypic burden in familial risk of bipolar disorder.Translational psychiatry · 2022Pooled it
- Environmental Risk Factors for Bipolar Disorders and High-Risk States in Adolescence: A Systematic Review.Medicina (Kaunas, Lithuania) · 2020Pooled it
- Symptom trajectories into eating disorders: A systematic review of longitudinal, nonclinical studies in children/adolescents.European psychiatry : the journal of the Association of European Psychiatrists · 2020Pooled it
- Initial and relapse prodromes in adult patients with episodes of bipolar disorder: A systematic review.European psychiatry : the journal of the Association of European Psychiatrists · 2020Pooled it
- Effects of Family-Focused Therapy vs Enhanced Usual Care for Symptomatic Youths at High Risk for Bipolar Disorder: A Randomized Clinical Trial.JAMA psychiatry · 2020Trial
- A Pharmacologic Algorithm for Youth Who Are at High Risk for Bipolar Disorder.Journal of child and adolescent psychopharmacology · 2017Trial
- Sleep disturbances as early indicators of incident psychiatric disease.European archives of psychiatry and clinical neuroscience · 2026Article
- Premorbid adjustment problems, negative symptoms, and cognitive impairment in a large international sample at clinical high risk for psychosis: Findings from the Accelerating Medicines Partnership-Schizophrenia.Schizophrenia bulletin · 2026Article
- Brainwide Structural Markers of Familial and Clinical Risk for Bipolar Disorder in Youth.Biological psychiatry. Cognitive neuroscience and neuroimaging · 2026Article
- Risk Factors Associated with Longitudinal Trajectories of Mania Symptoms in Youth.medRxiv : the preprint server for health sciences · 2026Article
- [Youth mental health: early detection and early intervention of mental disorders].Der Nervenarzt · 2026Review
- Dissociative Bipolar At-Risk Phenotype: Traumatic Burden and Subthreshold Affective Psychopathology in a Help-Seeking Youth Sample.Brain sciences · 2026Article
- Agreement between smartphone-based mobile sensing and actigraphy sleep metrics in young people with bipolar disorder.medRxiv : the preprint server for health sciences · 2026Article
- Validation and Extension of a Risk Calculator to Predict Mood Recurrence in Young People with Bipolar Disorder.medRxiv : the preprint server for health sciences · 2026Article
- Duration of Untreated Eating Disorder and Prodrome in Young People: Characteristics and Relationship to Early Outcomes.Early intervention in psychiatry · 2026Article
- Development and validation of a prognostic model and risk calculator for the estimation of bipolar-spectrum disorder risk in hospitalised adolescents with non-psychotic/non-bipolar mental disorders.Molecular psychiatry · 2026Article
- Arachnoid Cyst in the Posterior Fossa and Its Contested Association with Mania and Psychotic Symptoms in a Prepubertal Child: A Case Report.International medical case reports journal · 2026Article
23 more citing papers are in PubMed but not listed here.
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe aim of this study was to meta-analyze the prevalence of symptoms before an initial mood episode of bipolar disorder (BD) and the prevalence of subthreshold symptoms before a BD mood episode recurrence, to facilitate early identification and prevention.
methodSystematic literature reviews were conducted in PsycINFO and PubMed for prospective or retrospective studies reporting on the prevalence and longest duration of symptoms before an initial or recurrent mood episode of BD. Random effects meta-regression explored whether geographic location, age, percentage of female individuals, and study quality moderated the overall prevalence.
resultsIn 11 studies (n = 1,078), the prodrome preceding an initial mood episode lasted 27.1 ± 23.1 months (range, 4.6-130 months). In 10 studies (n = 1,000), the subthreshold symptoms preceding a recurrent mood episode lasted 1.0 ± 0.9 months (range, 0.5-1.3 months). The most common symptoms were largely consistent with diagnostic criteria symptoms associated with the subsequent mood polarity for both the initial prodrome and the period prior to a recurrent mood episode. Few moderators of symptom prevalences emerged, and significant heterogeneity remained.
conclusionThe initial prodromal period is sufficiently long and characterized by symptoms of the subsequent mood episode to make early identification and intervention programs feasible. Conversely, the period of subthreshold symptoms before a recurrent mood episode is short, mandating adequate psychoeducation of patients and families, monitoring of changes in sleep and activity, plus sufficiently frequent follow-up visits to identify patients before a mood episode recurrence. Future prospective investigations, designed to address the identified shortcomings in the extant literature, are needed to identify more clinically applicable information.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.