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Youth and\/or caregivers underwent semi\u2010structured interviews, using the Bipolar Prodrome Symptom Scale\u2013Retrospective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mania prodrome was reported to start gradually in most youth (88.5%), with either <jats:italic>slow<\/jats:italic> (59.6%) or <jats:italic>rapid<\/jats:italic> (28.8%) deterioration, while a <jats:italic>rapid\u2010onset\u2010and\u2010deterioration<\/jats:italic> prodrome was rare (11.5%). The manic prodrome, conservatively defined as requiring \u2265 3 symptoms, lasted 10.3\u00a0\u00b1\u00a014.4\u00a0months [95% confidence interval (<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>): 6.3\u201314.4], being present for\u00a0\u2265\u00a04\u00a0months in 65.4% of subjects. Among prodromal symptoms reported in \u2265 50% of youth, three were subthreshold manic in nature (irritability: 61.5%, racing thoughts: 59.6%, increased energy\/activity: 50.0%), two were nonspecific (decreased school\/work functioning: 65.4%, mood swings\/lability: 57.7%), and one each was depressive (depressed mood: 53.8%) or subthreshold manic\/depressive (inattention: 51.9%). A decreasing number of youth had \u2265 1 (84.6%), \u2265 2 (48.1%), or \u2265 3 (26.9%) \u2018<jats:italic>specific<\/jats:italic>\u2019 subthreshold mania symptoms (i.e., elation, grandiosity, decreased need for sleep, racing thoughts, or hypersexuality), lasting 9.5\u00a0\u00b1\u00a014.9\u00a0months (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 5.0\u201314.0), 3.5\u00a0\u00b1\u00a03.5\u00a0months (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 2.0\u20134.9), and 3.0\u00a0\u00b1\u00a03.2\u00a0months (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>: 1.0\u20135.0) for \u2265 1, \u2265 2, or \u2265 3 specific symptoms, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In youth with <jats:styled-content style=\"fixed-case\">BD<\/jats:styled-content>\u2010I, a relatively long, predominantly slow\u2010onset mania prodrome appears to be common, including subthreshold manic and depressive psychopathology symptoms. This suggests that early clinical identification and intervention may be feasible in bipolar disorder. Identifying biological markers associated with clinical symptoms of impending mania may help to increase chances for early detection and prevention before full mania.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.12194","type":"journal-article","created":{"date-parts":[[2014,3,5]],"date-time":"2014-03-05T12:36:44Z","timestamp":1394023004000},"page":"478-492","source":"Crossref","is-referenced-by-count":100,"title":["Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode"],"prefix":"10.1111","volume":"16","author":[{"given":"Christoph U","family":"Correll","sequence":"first","affiliation":[{"name":"The Zucker Hillside Hospital Psychiatry Research North Shore\u2013Long Island Jewish Health System Glen Oaks NY"},{"name":"Hofstra North Shore\u2013LIJ School of Medicine Hempstead NY"},{"name":"The Feinstein Institute for Medical Research North Shore\u2013Long Island Jewish Health System Manhasset 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