Symptoms of Affective Register as an Onset of Mental Disorders in Adolescents

Background: mental disorders of different origin often begin with affective symptoms. The inuence of adolescence is recognized and concerns psychopathological manifestations following diagnostics difculties. The aim of the study was to investigate the structure of mental disorders with symptoms of affective disorder in adolescents rstly admitted for psychiatric advice. Patients and method: the study involved 120 adolescents (aged 17.1 ± 2.37) who became patients of the psychoneurological dispensary for the rst time in 2020–2021 due to affective register symptoms. The clinical, psychopathological and statistical methods were used in the study. Results: all respondents had initial symptoms before seeking psychiatric help, the average age of occurrence of which was 14.5 ± 33.18 years. Among the initial manifestations, a decrease in mood, irritability, and emotional lability predominated. Symptoms detected at the initial stage, persisted until the moment of seeking psychiatric help, and were the cause of the violation of social adaptation: a decrease in academic performance in 52 cases (42.28%), school absences in 44 patients (35.77%), narrowing of the range of interests in 17 (13.82%) and conicts in 11 (8.94%) cases. At the same time, psychopathological symptoms noticed by the adolescents themselves and their parents were not a reason to seek help and, in most cases, were considered as manifestations of the puberty crisis. At the rst request of teenagers for psychiatric help, mood disorders (F30–F39) — 48,5%, neurotic, stress-related and somatoform disorders (F40–F49) — 25% dominated in the structure of diagnoses, according to ICD-10. Conclusions: mental disorders, including affective pathology, debuting in adolescence, can have a prodromal period and be often misinterpreted as a puberty crisis. The symptoms of affective disorder in adolescence differ in polymorphism and can lead to a variety of diagnoses. Underestimation of initial preclinical manifestations of affective pathology, despite signicant difculties in social adaptation, can result in untimely therapeutic intervention, severe clinical manifestations and conversion of the diseases into a chronic course. The obtained data conrm the need for a thorough differential diagnosis of initial manifestations of mental disorders, subsequent clinical and follow up care and proper treatment.

1. Kaleda VG, Migalina VV. Chronic endogenous depression sofyouth. S.S. Korsakov Journal of Neurology and Psychiatry/Zhurnal nevrologii i psikhiatrii imeni S.S. Korsakova. 2021;121(5–2):19–26. (In Russ.). doi: 10.17116/jnevro202112105219

2. Omelchenko МA, Kaleda VG. Vozmozhnosti vydeleniya klinicheskih markerov riska razvitiya shizofrenii. Interdisciplinarnyj podhod k komorbidnosti psihicheskih rasstrojstv na puti k integrativnomu lecheniyu: Sbornik tezisov, Saint Petersburg, 15–18 maya 2021 goda. Saint Petersburg. 2021:2211–2212. (In Russ.).

3. Baldessarini RJ, Tondo L, Vázquez GH. Pharmacological treatment of adult bipolar disorder. Mol Psychiatry. 2019;24(2):198–217. doi: 10.1038/s41380-0180044-2

4. Hayes JF, Miles J, Walters K, King M, Osborn DP. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand. 2015;131(6):417–425. doi: 10.1111/acps.12408

5. Ösby U, Westman J, Hällgren J, Gissler M. Mortality trends in cardiovascular causes in schizophrenia, bipolar and unipolar mood disorder in Sweden 1987-2010. Eur J Public Health. 2016;26(5):867–871. doi: 10.1093/eurpub/ckv245

6. Dickerson F, Origoni A, Schroeder J, Adamos M, Katsafanas E, Khushalani S, Savage CLG, Schweinfurth LAB, Stallings C, Sweeney K, Yolken R. Natural cause mortality in persons with serious mental illness. Acta Psychiatr Scand. 2018;137(5):371–379. doi: 10.1111/acps.12880

7. Chen TY, Kamali M, Chu CS, Yeh CB, Huang SY, Mao WC, Lin PY, Chen YW, Tseng PT, Hsu CY. Divalproex and its effect on suicide risk in bipolar disorder: A systematic review and meta-analysis of multinational observational studies. J Affect Disord. 2019;245:812–818. doi: 10.1016/j.jad.2018.11.093

8. Kazakovtsev BA, Demcheva NK, Yazdovskaya AV, Sidoryuk OV. Psychiatric assistance to the population of the Russian Federation in 2017. https:// www.elibrary.ru/item.asp?id=37088247& (accessed 9.3.20).

9. Rowland TA, Marwaha S. Epidemiology and risk factors for bipolar disorder. Ther Adv Psychopharmacol. 2018;8:251–269. doi: 10.1177/2045125318769235

10. Birmaher B. Four-year longitudinal course of children and adolescents with bipolar spectrum disorders: the Course and Outcome of Bipolar Youth (COBY) study. Am J Psychiat. 2009;166(7):795–804.

11. Findling RL, Jo B, Frazier TW, Youngstrom EA, Demeter CA, Fristad MA, Horwitz SM. The 24-month course of manic symptoms in children. Bipol Disord. 2013;15(6):669–679.

12. Berk M, Post R, Ratheesh A, Gliddon E, Singh A, Vieta E. Staging in bipolar disorder: from theoretical framework to clinical utility. World Psychiatry. 2017;16(3):236–244.

13. Kapczinski F, Dias VV, Kauer-Sant’Anna M, Brietzke E, Vázquez GH, Vieta E, Berk M. The potential use of biomarkers as an adjunctive tool for staging bipolar disorder. Prog Neuro-Psychopharmacol and Biol Psychiatry. 2009;33(8):1366–1371.

14. Post RM. Clinical staging in bipolar disorder: a historical perspective. Neuroprogression and Staging in Bipolar Disorder. 2015;2:1–16.

15. Post RM. The new news about lithium: an underutilized treatment in the United States. Neuropsychopharmacology. 2018;43(5):1174–1179. doi: 10.1038/ npp.2017.238

16. Etain B, Lajnef M, Bellivier F, Mathieu F, Raust A, Cochet B, Henry C. Clinical expression of bipolar disorder type I as a function of age and polarity at onset: convergent ndings in samples from France and the United States. J Clin Psychiatry. 2012;73(4):561–566.

17. Perlis RH, Miyahara S, Marangell LB, Wisniewski SR, Ostacher M, DelBello MP. Long-term implications of early onset in bipolar disorder: data from the rst 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2004;55(9):875–881. doi: 10.1016/j.biopsych.2004.01.022

18. Post RM, Altshuler LL, Kupka R, McElroy SL, Frye MA, Rowe M, Nolen WA. More childhood onset bipolar disorder in the United States than Canada or Europe: Implications for treatment and prevention. Neuroscien Biobehav Rev. 2017;4:204–213. doi: 10.1016/j. neubiorev.2017.01.022

19. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Swendsen J. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adoles Psychiatry. 2010;49(10):980–989.

20. Fava GA, Tossani E. Prodromal stage of major depression. Early Interv Psychiatry. 2007;1(1):9–18. doi: 10.1111/j.1751-7893.2007.00005.x

21. Bardenshteyn L, Slavgorodsky Ya, Beglyankin N, Kekelidze D, Aleshkina G. PS62. Early recognition of bipolar depression. International Journal of Neuropsychopharmacology. 2016;19:21–22. doi: 10.1093/ijnp/pyw043.062

22. Vöhringer PA, Perlis RH. Discriminating between bipolar disorder and major depressive disorder. Psychiatr Clin N Am. 2016;39(1):1–10. doi: 10.1016/j. psc.2015.10.001

23. Zimmerman M. Screening for bipolar disorder with self-administered questionnaires: a critique of the concept and a call to stop publishing studies of their performance in psychiatric samples. Depress Anxiety. 2017;34(9):779–785. doi: 10.1002/da.22644

24. Benazzi F, Akiskal H. Irritable-hostile depression: further validation as a bipolar depressive mixed state. J Affect Disord. 2005;84(2–3):197–207. doi: 10.1016/j. jad.2004.07.006

25. Frazier EA, Hunt JI, Hower H, Jones RN, Birmaher B, Strober M, Goldstein BI, Keller MB, Goldstein TR, Weinstock LM, Dickstein DP, Diler RS, Ryan ND, Gill MK, Axelson D, Yen S, Loftus J, Scott J, Vorspan F, Icick R, Henry C, Gard S, Kahn JP, Leboyer M, Bellivier F, Etain B. Psychiatric comorbidities in bipolar disorders: An examination of the prevalence and chronology of onset according to sex and bipolar subtype. J Affect Disord. 2020;267:258–263. doi: 10.1016/j.jad.2020.02.035

26. McDonald CE, Rossell SL, Phillipou A. The comorbidity of eating disorders in bipolar disorder and associated clinical correlates characterised by emotion dysregulation and impulsivity: a systematic review. J Affect Disord. 2019;259:228–243. doi: 10.1016/j.jad.2019.08.070

27. Baldessarini RJ, Tondo L, Visioli C. First-episode types in bipolar disorder: predictive associations with later illness. Acta Psychiatr Scand. 2014;129(5):383–392.

28. Gur’eva VA. K sistematike pubertatnoj psihopatologii. V kn.: Sovremennye problem podrostkovoj obshcei I sudebnoi psichiatrii. M. 1987:3–12. (In Russ.).

29. Muzychenko EN, Vandysh VV. Vozrastnaya dinamika psihicheskih rasstrojstv podrostkovogo vozrasta (po dannym sudebno-psihiatricheskoj ekspertizy). Bekhterevskie chteniya: Sb. nauch. tr. SPb.; Kirov. 2003:105–108. (In Russ.).