Early Screening for Risks of Bipolar Disorder at the Preclinical Stage.

INTRODUCTION: Bipolar disorder (BD) is characterized by a high rate of prevalence in the general population varying from 0.6% to 5.84% (Yildiz 2015). BD is one of the leading causes of disability and mortality from suicide and comorbid diseases (Johnson et al. 2017). Individual symptoms of the disease in the form of cyclothymia-like mood fluctuations can be detected in adolescence and have potential for predicting risk for BD (Tijssen et al. 2010). The key issue here is untimely diagnosis of BD (Mosolov et al. 2014, Bardenshteyn et al. 2016). Early screening for risks of bipolar disorder at the preclinical stage. SUBJECTS AND METHODS: The study involved 137 students aged from 18 to 20 years (mean age 18.93±0.09). The clinical-psychopathological method as well as the screening method of research were used: the Mini-International Neuropsychiatric Interview (M.I.N.I.), (Sheehan et al. 1998), the Hamilton Depression Rating Scale (HDRS 1960), the Mood Disorder Questionnaire (MDQ) (Hirschfeld 2000). The statistical data processing included descriptive statistical methods (p<0.05). RESULTS: Clinical diagnostics of the responders using ICD-10 (WHO, 1992, Chapter V [F00-F99]) excluded the diagnosis of bipolar disorder. The MDQ screening method revealed a statistically significant excess of the average values for hypomania throughout the sample (M±m: 6.46±0.44; p<0.05). The total score of 64 interviewees (46.7%; 95% CI: 38.1-55.3) exceeded the threshold value (≥7). 68 responders (49.6%; 95% CI 41.0-55.3) showed one-stage manifestation of certain signs of mood rise. 72 interviewees (52.6%; 95% CI 43.9-58.3) reported absence of mood rise, associated with conflict behaviour, family problems etc. According to the HDRS scale, 45 responders (32.85%; 95% CI: 24.14-40.95) showed signs of mild depression (M±m: 6.51±0.39; p<0.05). Also, a group of responders (18.2%; 95% CI: 11.78-24.72) manifested exceeding indicators both for hypomania and depression. CONCLUSIONS: According to the MDQ scale, 46.7% of the responders showed threshold values exceeding; with the one-stage manifestation of hypomania signs in 49.6% of the respondents. 32.85% of the responders showed signs of mild depression (the HAMD scale). 18.2% of the interviewees exceeded threshold values for both hypomania and depression. The discovered cyclothymia-like conditions at the preclinical stage have potential for predicting risk for their transformation to bipolar disorder which directs further outpatient clinical and dynamic observation.

[Clinical features of depressive episode with onset in adolescence and the risk of bipolar depression]. / Osobennosti depressivnogo épizoda s debiutom v podrostkovom vozraste i risk razvitiia bipoliarnoi depressii.

AIM: To study clinical features of depressive episode with the onset in late adolescence associated with the risk of bipolar affective disorder (BAD). MATERIAL AND METHODS: Forty patients with BAD (ICD-10 F31), who experienced depressive state at the age of 15-18 years corresponding to the diagnostic criteria of 'Depressive episode' (F32), were examined. The duration of follow-up was from 3 to 5 years. Clinical-psychopathologic, follow-up, statistical methods were applied. RESULTS: Duration of depressive episodes did not exceed 6 months in 70% of patients with BAD. Characteristic clinical features included the frequent presence of psychomotor retardation, anergia, anhedonia, melancholy, irritability, affective instability with increased emotional reactivity, hypersomnia. Other 'atypical' depressive symptoms were less characteristic. There was a significant incidence of suicidal tendencies, comorbid psychopathic-like behavioral disorders and substance abuse. In most cases, the depressive state was accompanied by a deterioration in social functioning and led to educational maladaptation. CONCLUSION: Characteristic clinical features of bipolar depression manifested in late adolescence were a relatively short duration, the prevalence of typical depressive symptoms (melancholy, psychomotor retardation), irritability, increased emotional reactivity, hypersomnia, a significant incidence of suicidal tendencies.

[Predictors of suicidal behaviour in adolescents with depressive disorders]. / Prediktory suitsidal'nogo povedeniia u podrostkov s depressivnymi rasstroistvami.

A review of recent publications is devoted to risk factors for suicidal behavior in adolescents with depressive disorders. The authors summarized Russian and international studies on the clinical course of affective disorders, in particular bipolar disorders, their clinical heterogeneity and incompleteness in adolescence. Particular attention is given to the complexity of early identification of predictors of suicidal behavior in depressive disorders due to comprehensiveness of exogenous and endogenous effects characteristic of adolescence. The role of genetic loading for affective disorders, problems of children having parents with affective disorders, social and psychological factors (violence in families, school bullying etc.) and risks of suicidal behavior are described. It is of great significance to investigate premorbid adjustment, subaffective manifestations of disorders in adolescence to predict the trajectory of the disease, its complications in the form of suicidal behavior and opportunities for early intervention.