Prodromes, coping strategies and course of illness in bipolar affective disorder - a naturalistic study

Background. Psychosocial interventions for bipolar patients often include t eaching patients to recognize prodromal symptoms and tackle them early. Thi s prospective study set out to investigate which bipolar prodromal symptoms were reported frequently and reliably over a period of 18 months. Furtherm ore, we have also investigated which types of coping strategies were relate d to good outcome. Method. Forty bipolar patients were interviewed for their bipolar prodromal symptoms and their coping strategies at recruitment and 18 months later. P atients were also assessed as to whether they had experienced relapses. Results. Bipolar patients were able to report bipolar prodromal symptoms re liably. Mania prodromal symptoms tended to be behavioural symptoms. A quart er of patients reported difficulties in detecting depression prodromes, whi ch tended to be more diverse and consisted of a mix of behavioural, cogniti ve and somatic symptoms. Significantly fewer patients who reported the use of behavioural coping strategies to curb excessive behaviour during the man ia prodromal stage experienced a manic episode. Similarly, significantly fe wer patients who reported the use of behavioural coping strategies experien ced depression relapses. How well patients coped with mania prodromes predi cted bipolar episodes significantly when the mood levels at baseline were c ontrolled. Ratings of how well subjects coped with mania prodromal symptoms also predicted manic symptoms significantly at T2 when manic symptom at T1 was controlled. Conclusion. Our study suggests that bipolar patients are able to report pro dromal symptoms reliably. It is advisable to teach patients to monitor thei r moods systematically and to promote good coping strategies.