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Bipolar At-Risk Criteria: An Examination of Which Clinical Features Have Optimal Utility for Identifying Youth at Risk of Early Transition from Depression to Bipolar Disorders

Lookup NU author(s): Emeritus Professor Jan Scott, Dr Iain Macmillan

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Abstract

© The Author 2017. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. Background: A clinical and research challenge is to identify which depressed youth are at risk of "early transition to bipolar disorders (ET-BD)." This 2-part study (1) examines the clinical utility of previously reported BD at-risk (BAR) criteria in differentiating ET-BD cases from unipolar depression (UP) controls; and (2) estimates the Number Needed to Screen (NNS) for research and general psychiatry settings. Methods: Fifty cases with reliably ascertained, ET-BD I and II cases were matched for gender and birth year with 50 UP controls who did not develop BD over 2 years. We estimated the clinical utility for finding true cases and screening out non-cases for selected risk factors and their NNS. Using a convenience sample (N = 80), we estimated the NNS when adjustments were made to account for data missing from clinical case notes. Results: Sub-threshold mania, cyclothymia, family history of BD, atypical depression symptoms and probable antidepressant-emergent elation, occurred significantly more frequently in ET-BD youth. Each of these "BAR-Depression" criteria demonstrated clinical utility for screening out non-cases. Only cyclothymia demonstrated good utility for case finding in research settings; sub-threshold mania showed moderate utility. In the convenience sample, the NNS for each criterion ranged from ∼4 to 7. Conclusions: Cyclothymia showed the optimum profile for case finding, screening and NNS in research settings. However, its presence or absence was only reported in 50% of case notes. Future studies of ET-BD instruments should distinguish which criteria have clinical utility for case finding vs screening.

Publication metadata

Author(s): Scott J, Marwaha S, Ratheesh A, Macmillan I, Yung AR, Morriss R, Hickie IB, Bechdolf A

Publication type: Article

Publication status: Published

Journal: Schizophrenia Bulletin

Year: 2017

Volume: 43

Issue: 4

Pages: 737-744

Online publication date: 21/11/2016

Acceptance date: 02/04/2016

ISSN (print): 0586-7614

ISSN (electronic): 1745-1701

Publisher: Oxford University Press

URL: https://doi.org/10.1093/schbul/sbw154

DOI: 10.1093/schbul/sbw154

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