Genuine clinical predictors of bipolar II disorder: An exploration of temporal and contextual characteristics

Abstract Background Symptoms of the initial prodrome of bipolar disorder (BD) are too nonspecific to reliably prospectively predict BD. An assessment of symptoms' temporal and contextual characteristics may help identify clinical indicators with enhanced predictive power. Methods Fifteen bipolar II disorder (BD-II) patients and 22 family members were interviewed about characteristics of symptoms that emerged before the first major affective episode (FMAE). The textual data of transcribed interviews were analyzed utilizing qualitative methodology. To identify genuine clinical predictors (GCPs), we outlined three alternative definitions and investigated the extent to which the reported symptoms in different symptom categories survived successively narrower inclusion criteria. Results Most of the reported symptom instances met the broadest GCP criteria as episodic or chronic. “Mood swings” and “irritability/aggressiveness” were the only symptom categories in which most of the reported symptom instances met our intermediate strict criteria as episodic/chronic, and exaggerated/inexplicable. The mood swings were mainly characterized as episodic and occurred for no apparent reason; conversely, irritability and aggressiveness were typically characterized as episodic and exaggerated responses to life events. Limitations This is a retrospective and hypothesis-generating study. Conclusions Recurrent mood swings and irritability/aggressiveness are characterized as inexplicable and exaggerated responses, respectively, and may be the most prominent genuine clinical predictors of the FMAE of BD-II. Future studies need to investigate the extent to which the presence of different characteristics of the same symptoms discriminate between individuals who later develop BD and those who do not.