Prodrome

These may prove the Prodromes […] to the ruin of our Monarchy.

It is becoming increasingly recognised that bipolar, like schizophrenia, has a prodromal phase which can be identified prior to development of the full illness. However, one issue with research into this area is the potential conflation of the concepts of a prodrome for bipolar, referring to symptoms that can be retrospectively identified as preceding the onset of the disorder, and a ‘risk syndrome’ consisting of clinical features, comorbidities and risk factors which increase the risk of later developing bipolar. At present, neither prodrome nor risk syndrome has been fully defined, although the bipolar at-risk (BAR) assessment tool has demonstrated predictive validity and reliability for identifying those at risk of bipolar, with around 23% of those identified transitioning to mania or hypomania.