Related Experiment Video
Updated: Aug 17, 2025
Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Naïve Adolescents at High Risk for Psychosis
Published on: November 21, 2013
Course of subthreshold manic symptoms and related risk factors in the general population: A three-year follow-up
Rosalie A L Beekman1, Margreet Ten Have2, Ron de Graaf2
1Altrecht Institute for Mental Health Care, Utrecht, The Netherlands.
Objectives:
Subthreshold manic symptoms (subM) are a risk factor for the onset and recurrence of bipolar disorder (BD). Individuals with subM may benefit from preventive interventions, however, their development is hampered by a lack of knowledge on subM prevalence and subsequent course. This study examines subM characteristics, course, and risk factors for an unfavourable course.
Methods:
In a Dutch representative, population-based sample aged 18-64 (N = 4618), we assessed subM, defined as the occurrence of manic core symptoms (elation/irritability), without meeting full DSM-IV criteria for BD I or II in the past 3 years. Comparison groups had either no manic symptoms (noM) or hypomania/mania in the context of BD (mBD) in the past 3 years. Furthermore, we differentiated a mild and moderate type of subM, based on the number of manic symptoms. A subsequent three-year course was assessed prospectively.
Results:
SubM had a three-year prevalence of 4.9%. Its prevalence, characteristics, and course were in between noM and mBD, and there were few differences between mild and moderate subM. Over the 3-year follow-up, 25.0% of individuals with subM had persistent subM and another 6.1% transitioned to mBD. Eleven significant risk factors for this unfavourable course were found. The most important were a history of depression/dysthymia (OR 3.75, p ≤ 0.001), living alone (OR 2.61, p ≤ 0.01) and elevated neuroticism score (OR 1.21, p ≤ 0.001).
Conclusions:
This study supports the validity and clinical relevance of subM as a BD prodrome. It demonstrates that subM symptoms often persist or increase during follow-up and identifies 11 risk factors that are associated with an unfavourable course.
Insights
Subthreshold manic symptoms (subM) are a significant risk factor for bipolar disorder (BD). Over three years, 25% of individuals with subM experienced persistent symptoms, highlighting the need for early intervention.
Area of Science:
- Psychiatry
- Clinical Psychology
- Epidemiology
Background:
- Subthreshold manic symptoms (subM) are recognized as a risk factor for the development and recurrence of bipolar disorder (BD).
- Understanding the prevalence and course of subM is crucial for developing effective preventive interventions.
- This study investigates the characteristics, longitudinal course, and risk factors associated with an unfavorable outcome in individuals with subM.
Purpose of the Study:
- To determine the prevalence and characteristics of subthreshold manic symptoms (subM) in a representative population.
- To prospectively assess the three-year course of subM, including persistence and transition to bipolar disorder (BD).
- To identify risk factors associated with an unfavorable course of subM.
Main Methods:
- A population-based sample of 4618 Dutch adults (aged 18-64) was assessed for subM, defined as manic core symptoms without meeting full BD criteria.
- Participants were categorized into groups with subM, no manic symptoms (noM), or manic symptoms within diagnosed BD (mBD).
- SubM was further classified as mild or moderate based on symptom count, and a three-year prospective follow-up was conducted.
Main Results:
- The three-year prevalence of subM was 4.9%, with its characteristics and course falling between noM and mBD groups.
- During the 3-year follow-up, 25.0% of individuals with subM experienced persistent symptoms, and 6.1% transitioned to mBD.
- Eleven significant risk factors for an unfavorable course were identified, including a history of depression/dysthymia (OR 3.75), living alone (OR 2.61), and elevated neuroticism (OR 1.21).
Conclusions:
- Subthreshold manic symptoms (subM) are clinically relevant and may represent a prodromal phase of bipolar disorder (BD).
- SubM symptoms frequently persist or worsen over time, underscoring the need for clinical attention.
- Identifying specific risk factors can aid in predicting and managing individuals with subM who are at higher risk for an unfavorable trajectory.
More Related Videos
10:46A Method of Trigonometric Modelling of Seasonal Variation Demonstrated with Multiple Sclerosis Relapse Data
Published on: December 9, 2015
07:31Implementation of a Real-Time Psychosis Risk Detection and Alerting System Based on Electronic Health Records using CogStack
Published on: May 15, 2020
Related Concept Videos
01:30Bipolar Disorder
01:24Mania and Antimanic Drugs: Overview
01:29Psychological and Sociocultural Causes of Schizophrenia
02:20Longitudinal Research
01:30Stress and Mental Health
Individuals with depression often experience challenges in both their personal and professional...
01:27Depressive Disorders: Etiology
Biological Factors in Depression
Biological predispositions significantly influence the risk of developing depressive disorders. Genetic studies highlight the role of variations in the serotonin transporter...