The following is a summary of “A transdiagnostic prodrome for severe mental disorders: an electronic health record study,” published in the May 2024 issue of Psychiatry by Arribas et al.

Understanding the early stages (prodromes) of severe mental disorders (SMD) like unipolar and bipolar mood disorders (UMD/BMD) and psychotic disorders (PSY) is crucial for effective prevention. However, details on the duration, first appearance, time course, and standard features of these stages are essential but lacking.

Researchers conducted a retrospective study investigating the duration, first presentation, time course, and standard features of prodromal stages in different types of SMD.

They used electronic health records, following RECORD guidelines and natural language processing, to extract monthly occurrences of 65 prodromal features that were later grouped into eight prodromal clusters. Statistical analyses like ANOVA, Cohen’s f and d, and linear mixed-effects models were used to identify the primary endpoints.

The results studied 26,975 individuals diagnosed with ICD-10 SMD over up to 12 years (13,422 UMD, 2506 BMD, 11,047 PSY; median IQR age 39.8 [23.7], 55% female; 52% white). The prodrome duration was shorter for non-psychotic UMD (18[36] months) compared to BMD (26 [35], d=0.21) and PSY (24 [38], d=0.18). Most individuals experienced multiple prodromal clusters, with a joint first presentation being non-specific symptoms (‘other,’ 88% UMD, 85%BMD, 78% PSY). Positive symptoms showed differences between SMD groups (f=0.30). Prodromal clusters intensified as individuals approached SMD onset, and most features were transdiagnostic except positive symptoms (like paranoia, f=0.40).

Investigators concluded that the prodrome duration and presentation are similar across different severe mental disorder types. All prodromal symptoms increase before disorder onset, supporting transdiagnostic preventive approaches in mental healthcare.

Source: nature.com/articles/s41380-024-02533-5