{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:43:27Z","timestamp":1784558607679,"version":"3.55.0"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,12,26]],"date-time":"2022-12-26T00:00:00Z","timestamp":1672012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Bipolar Disorders"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Subthreshold manic symptoms (subM) are a risk factor for the onset and recurrence of bipolar disorder (BD). Individuals with subM may benefit from preventive interventions, however, their development is hampered by a lack of knowledge on subM prevalence and subsequent course. This study examines subM characteristics, course, and risk factors for an unfavourable course.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a Dutch representative, population\u2010based sample aged 18\u201364 (<jats:italic>N<\/jats:italic>\u00a0=\u20094618), we assessed subM, defined as the occurrence of manic core symptoms (elation\/irritability), without meeting full DSM\u2010IV criteria for BD I or II in the past 3\u2009years. Comparison groups had either no manic symptoms (noM) or hypomania\/mania in the context of BD (mBD) in the past 3\u2009years. Furthermore, we differentiated a mild and moderate type of subM, based on the number of manic symptoms. A subsequent three\u2010year course was assessed prospectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>SubM had a three\u2010year prevalence of 4.9%. Its prevalence, characteristics, and course were in between noM and mBD, and there were few differences between mild and moderate subM. Over the 3\u2010year follow\u2010up, 25.0% of individuals with subM had persistent subM and another 6.1% transitioned to mBD. Eleven significant risk factors for this unfavourable course were found. The most important were a history of depression\/dysthymia (OR 3.75, <jats:italic>p<\/jats:italic>\u00a0\u2264\u20090.001), living alone (OR 2.61, <jats:italic>p<\/jats:italic>\u00a0\u2264\u20090.01) and elevated neuroticism score (OR 1.21, <jats:italic>p<\/jats:italic>\u00a0\u2264\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study supports the validity and clinical relevance of subM as a BD prodrome. It demonstrates that subM symptoms often persist or increase during follow\u2010up and identifies 11 risk factors that are associated with an unfavourable course.<\/jats:p><\/jats:sec>","DOI":"10.1111\/bdi.13285","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T13:12:58Z","timestamp":1671023578000},"page":"148-157","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Course of subthreshold manic symptoms and related risk factors in the general population: A three\u2010year follow\u2010up study"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1427-5764","authenticated-orcid":false,"given":"Rosalie A. 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