An unsteady mood and sleeping problems often occur just before the onset of both bipolar disorder type I and bipolar disorder type II, according to a new study published in the Journal of Affective Disorders. The earliest signs to appear often include irritability, impatience, social isolation, weight gain, tiredness and suspiciousness.

These symptoms “might be indicators for early recognition of bipolar disorder,” said Dr. Eike Zeschel of Ruhr University, Bochum (Germany), and associates.

For example, patients with both bipolar disorders frequently reported mood changes and disturbed daily rhythm during the months leading up to their first depressive or manic episode, said the researchers. Psychosis-like symptoms occurred significantly more often before a depressive episode than a manic episode.

For the study, Zeschel and colleagues performed structured interviews with 42 bipolar patients who were being treated at three university hospitals in Germany. They assessed 39 symptoms and signs that first began or became worse before the first manic or depressive episode.

The mean age of these study subjects was 35 years, and approximately 60 percent of them were women. A total of 27 patients had bipolar disorder type I and 15 had bipolar disorder type II.

All but one patient were taking psychotropic medication at the time of the interview. Overall, every patient with type I bipolar disorder and all but one patient with type II reported having at least one pre-onset symptom just before their first episode.

The pre-depressive symptoms lasted significantly longer (4.1 months) than did the pre-manic symptoms (1.3 months). However, the frequency and severity of symptoms were similar between the two types of bipolar disorder.

The most common symptoms leading up to the first depressive episode were depressed mood, reduced energy, physical exhaustion, tiredness and social isolation. In contrast, the most frequently reported symptoms just before the first manic episode were feeling extremely energetic, physical agitation, talkativeness, racing thoughts and low requirement for sleep.

In general, early symptoms showed “a progressive, accelerating course toward a full-blown mood episode.” Symptoms “became more prevalent and more specific to the respective affective phase the closer the patients got to their mood episode,” the investigators added.

However, general symptoms such as unsteady mood and disrupted sleep patterns also occurred frequently in both groups of patients. The first symptoms to appear in both patient groups were irritability, impatience, social isolation, weight gain, tiredness and suspiciousness.

These findings highlight “the necessity to inquire about the patients’ entire psychopathological symptom ‘package’ and not only about specific affective symptoms when suspecting that they may be developing bipolar disorder,” said the researchers.

This article first appeared on ‘Psych Central’ on 21 December 2013.