Clinical and demographic features associated with the detection of early warning signs in bipolar disorder.

Aim: The detection of early warning signs is a major component of many psychological interventions for assisting in the management of bipolar disorder. The aim of this study was to assess whether the ability to detect early warning signs was associated with clinical and demographic characteristics in a bipolar disorder clinic sample.

Method: Two-hundred-and-one participants with DSM-IV bipolar I or II disorder aged over 18 years of age were recruited through a specialized bipolar disorder clinic. Participants were administered a structured interview by psychiatrists asking participants about any early warning signs, and features of the phenomenology, course and treatment of bipolar disorder.

Results: Participants were significantly more likely to recognise both hypo/manic and depressive early warning signs rather than only one type of mood episode. The ability to detect signs of both hypo/mania and depression was greater in younger participants. The ability to detect signs of depression was associated with more prior depressive episodes and a lesser likelihood of prior hospitalisations whilst a history of mixed mood was associated with a greater likelihood of detecting depressive symptoms. The ability to recognise signs of hypo/mania was greater in those reporting a history of visual hallucinations (during depressive and/or manic episodes).

Limitations: Cross-sectional design and previous experience with psychotherapy was not assessed.

Conclusion: These findings provide useful clinical data pertinent to psychological interventions for bipolar disorder. Longitudinal studies are needed to further examine how the ability to recognise early warning signs may be associated with longer term outcome.