Akademik Veri Yönetim Sistemi
13th International Congress on Psychopharmacology & International Symposium on Child and Adolescent Psychopharmacology (ICP 2022), Antalya, Türkiye, 9 - 12 Kasım 2022, ss.83-84
Bipolar disorder is a severe, recurrent and disabling disorder with devastating consequences for
the individual, family and society. It also shortens life expectancy, imposes high costs on
healthcare systems, and carries a high risk of relapse and recurrence. The risk of relapse and
recurrence within two years of the first episode is approximately 60 percent. In addition, more
than half of patients experience more than one episode. Even in patients treated conservatively,
the risk of relapse and recurrence is about 25%. Evidence suggests that recurrent episodes in
bipolar disorder are associated with progressive structural changes in the brain, such as thinning
of the gray matter, enlargement of the ventricles, deterioration of cognitive function, and
decreased functionality and responsiveness to treatment. Therefore, recognition of prodromal
signs is important to prevent episodes and neurodegeneration caused by episodes, reduce the
need for hospitalization, cause fewer cognitive deficits, improve disease prognosis, and
preserve neuroplasticity by allowing early diagnosis and early interventions.
Prodromal signs can be defined as early symptoms and signs that are distinct from the acute
clinical phase. In studies conducted in patients with bipolar disorder, a significant proportion
of patients have been reported to have subthreshold manic or depressive prodromal symptoms,
including elevated or irritable mood, increased energy, racing thoughts, slurred speech,
depressed mood, anhedonia, sleep disturbances, fatigue, self-harm, and suicidal ideation. It
reportedly takes an average of 10 years from onset to definite diagnosis for patients with bipolar
disorder. Considering the high morbidity, mortality, and chronic course caused by delay in
diagnosis, the importance of recognizing prodromal symptoms for early diagnosis and
treatment becomes clear.
Apart from the recurrent episode periods, sub-threshold residual symptoms often occur in
bipolar disorder. Subtle signs of disease that persist despite significant improvement are
referred to as residual symptoms. In clinical practice, residual symptoms are ignored, and the
focus is on the recurrent episode periods. However, in a chronic disorder that progresses with
remissions and exacerbations, residual symptoms are essential in that they have a high
probability of recurrence. Residual symptoms impair the patient's quality of life and have a
negative impact on functionality. There are studies that report that the negative impact of
residual symptoms, particularly depressive symptoms, on social and psychosocial functioning
is more pronounced. In one study, it was shown that more than half of the patients had residual
manic and depressive symptoms. In another study, residual manic and depressive symptoms
were found to affect the number of perseverative errors, fluency of speech, and ability to plan. A study examining 74 patients reported that 68 percent had residual mania symptoms and 54
percent had residual depression symptoms. Residual symptoms can be classified as moodrelated, cognitive, neurovegetative, social, and behavioral.
Prodromal and residual symptoms are ignored during clinical follow-up of patients with bipolar
disorder. Detection of prodromal symptoms and early intervention are critical for delaying
episodes, reducing the severity of episodes, and even preventing relapse, recurrence, and
hospitalization. Residual symptoms impair the patient's quality of life between episodes,
predispose to new episodes, and lead to a worse disease course. In addition, the importance of
psychoeducation, family interview, maintenance therapy, and long-term clinical follow-up for
prodromal and residual symptom detection and early intervention is becoming increasingly
clear.
Keywords: bipolar disorder, prodromal symptoms, residual symptoms, functionality, quality
of life, prognosis