EPV232 - Ultra-Early Warning Signs of Mania in Participants of Bipolar Disorder Psychoeducation Groups: a Pilot Mapping Study

EPV232

Ultra-Early Warning Signs of Mania in Participants of Bipolar Disorder Psychoeducation Groups: a Pilot Mapping Study

G. Barilla' ¹, C. Venco ^1,*, M. Cattolico ¹, S. Pacchioni ¹, M. Melli ¹, C. Soragna ¹, G. Lucchini ¹, D. Bussolotti ¹

¹ASST Mantua, Department of Mental Health and Addictions, Mantua, Italy

 

Introduction: Early relapse detection is pivotal in bipolar disorder (BD). Colom & Vieta’s group psychoeducation model teaches patients to identify personal prodromes and ultra-early warning signs (UEWS) that precede mania/hypomania by days or weeks (Colom & Vieta. Psychoeducation Manual for Bipolar Disorder. Cambridge Univ Press 2006). Each UEWS must be specific, subtle, easily recognisable and clearly different from baseline behaviour. 
Early-sign training improves time to recurrence and reduces hospitalisation when added to pharmacotherapy (Morriss et al. Cochrane Database Syst Rev 2007). Our Mantua service has delivered this model since 2014, but UEWS content reported by our patients has not been systematically mapped.

Objectives: To map UEWS of emerging mania reported by psychoeducated BD patients and explore patterns by sex and age.

Methods: Two Colom-model bipolar psychoeducation groups in 2024 were included; all attendees were invited. Inclusion criteria: DSM-5 BD I/II, ≥ 2 manic or hypomanic episodes, ≥ 2 months euthymia. Twenty-five patients consented (mean age 47 ± 14 years; 13 women).  A trained nurse led a ten-minute structured recall: “What is the first small change you notice before becoming ‘too high’?”.  Two clinicians independently coded verbatim UEWS into nine a priori domains (sleep, appearance/self-care, activity, social/interpersonal, behaviour/media, risk/impulsivity, appetite, mood, cognition/functioning) adapted from the Manual and manic-prodrome research. Inter-rater κ = 0.86; discrepancies were resolved by consensus. Frequencies were tallied; χ² tests compared domain distributions by sex and age (< 40, 40–59, ≥ 60); α = 0.05.

Results: We identified 73 UEWS (median 3 per patient; range 1–6). Frequent domains were appearance/self-care (23 %), sleep/biological rhythm (17 %), activity/energy (16 %), behaviour/hobbies/media (14 %) and risk/impulsivity (11 %); other domains accounted for 19 %. Increased attention to appearance, waking slightly earlier, extra exercise, increased social-media posting and faster driving were the most common individual UEWS. Appearance/self-care UEWS were significantly more common in women than in men (68 % vs 32 %; χ² = 4.7, p = 0.03). Patients < 40 years mentioned digital-media or music-related UEWS about twice as often as those ≥ 60 (χ² = 4.2, p = 0.04), whereas older adults more often reported changes in food quantity.

Conclusions: UEWS of mania in psychoeducated BD patients cluster into a limited set of recognisable domains and show sex- and age-related patterns. Integrating a concise nine-domain UEWS checklist into routine group psychoeducation may enable ultra-early, patient-led activation of behavioural strategies, clinician contact and pharmacological adjustment, shortening time to intervention beyond standard prodrome-based relapse prevention.

 

Disclosure of Interest: None Declared