Identification and management of prodromal symptoms in bipolar affective disorder: the role of individual, disorder, and treatment-related factors.

摘要

Background: Traditional psychosocial treatments have been adapted for use withudindividuals with bipolar affective disorders due to the limited prophylactic nature ofudpharmacotherapy and the recognition of the role of psychosocial factors in the course ofudthis disorder. Psychosocial interventions that include a prodromal monitoring andudmanagement component have been empirically shown to be an effective adjunct toudmedication for the treatment of bipolar disorder.udAims: There is a deficit of quantitative research that examines the impact of individualrelatedud(e.g. age, self-efficacy), disorder-related (e.g. time since diagnosis, experience ofudprodromal symptoms) and treatment-related (e.g. level of psychosocial input) factors onudindividuals’ ability to manage this disorder via the use of prodromal monitoring. Theudcurrent research aimed to investigate factors that are associated with the identificationudand management of prodromal symptoms.udMethod: Participants completed five self-report measures in order to provideudinformation on their experience of prodromal symptoms, current mood state, generaludself-efficacy, view of social support from significant others, and demographic andudclinical-related variables. The data were collected from 101 participants, 58 of whomudwere female. The sample consisted of individuals with a diagnosis of bipolar disorderudtype I and II.udResults: Univariate and bivariate analyses were used to explore the relationship betweenudindividual, disorder, and treatment-related variables associated with participants’udexperience of bipolar disorder. Variables that were significantly associated withudparticipants’ perception of their ability to identify and manage prodromes were furtherudinvestigated using ordinal logistic regression analyses.udThe results indicated that general self-efficacy and prodromal-specific help fromudsignificant others were associated with an increase in participants’ perception of theirudability to identify manic and depressive prodromal symptoms. General self-efficacy wasudalso associated with participants’ view of their ability to manage cognitive andudbehavioural prodromes. Experience of prodromal symptoms (e.g. consistency ofudsymptoms experienced, type of prodrome experienced) was associated the participants’udperception of their ability to identify and manage prodromes. In general, disorder-relatedudvariables (e.g. time since diagnosis, mood state, diagnosis type, and number of episodesudexperienced) were not significantly associated with the participants’ view of their abilityudto identify and manage prodromal symptoms. Individual-related variables such as genderudand age, however, were associated with prodromal identification.udConclusion: The results indicated the need to consider constructs such as general selfefficacyudand experience of prodromal symptoms (e.g. consistency of symptoms, types ofudprodromes experienced, and ability to recognise prodromes when they first present)udwhen helping patients to learn how to identify and manage prodromal symptoms. Inudaddition gender differences and the role of help from significant others were highlightedudas variables that should be considered when using prodromal monitoring approachesudwith patients with bipolar disorder. Limitations of the research are reviewed in relationudto the methodology used. Clinical implications and directions for future research areudconsidered.