The predictive validity of bipolar at‐risk (prodromal) criteria in help‐seeking adolescents and young adults: a prospective study

Bechdolf, Andreas; Ratheesh, Aswin; Cotton, Sue; Nelson, Barnaby; Chanen, Andrew M; Betts, Jennifer; Bingmann, Tiffany; Yung, Alison R.; Berk, Michael; McGorry, Patrick D.

doi:10.1111/bdi.12205

Cited by 112 publications

(132 citation statements)

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“…34 Retrospective and prospective studies have revealed a pattern of putative prodromal symptoms, of which mood lability/mood swings/cyclothymic features, depressive mood, racing thoughts, irritability, and physical agitation are most commonly reported. 4,21 Considering that the onset of first manic episode occurs mainly in adolescence and early adulthood, it can be assumed that mild, poorly differentiated, or nonspecific symptoms influence the earliest developmental stages of the individual. 35,36 In fact, retrospective studies have shown that BD patients may report symptoms as early as 2 years of age, even though these manifestations are highly unspecific (such as sleep disorders or excessive crying).…”

Section: Clinical Presentation Of Early Stagesmentioning

confidence: 99%

“…57,59 Prospective studies of individuals at clinical risk of BD Prospective studies of individuals at risk of BD present a potentially reliable and valid approach to understanding the progression of BD psychopathology. 4,66 Many studies use enrichment strategies to enhance the possibility of studying a sample in which a large proportion of subjects experience onset of BD. However, the disadvantage of this approach is that it may limit the universality of findings, due to lack of power or specificity for predicting BD as compared to onset of a range of mental disorders.…”

Section: Retrospective Designsmentioning

confidence: 99%

“…[1][2][3] Recently, a focus on prevention, including early detection and intervention, has begun to attract increasing attention, as such strategies have the potential to delay, lessen the severity, prevent progression, or even prevent full-blown BD. 4,5 The notion that BD is a condition that follows a reasonable, predictable course across stages was a key aspect in developing proposals for prevention and early intervention. 6 Indeed, there are consistent data suggesting that, at least for a large subgroup of patients, BD actually follows a progressive course, which can be observed both in clinical outcomes (such as functional impairment) and in neurobiological findings (such as structural brain damage).…”

Section: Introductionmentioning

confidence: 99%

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Challenges and developments in research of the early stages of bipolar disorder

Brietzke

Rosa

Pedrini

et al. 2016

Rev. Bras. Psiquiatr.

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Recently, attention in the field of bipolar disorder (BD) has focused on prevention, including early detection and intervention, as these strategies have the potential to delay, lessen the severity, or even prevent full-blown episodes of BD. Although knowledge of the neurobiology of BD has advanced substantially in the last two decades, most research was conducted with chronic patients. The objective of this paper is to comprehensively review the literature regarding the early stages of BD, to explore recent discoveries on the neurobiology of these stages, and to discuss implications for research and clinical care. The following databases were searched: PubMed, PsycINFO, Cochrane Library, and SciELO. Articles published in English from inception to December 2015 were retrieved. Several research approaches were used, including examination of offspring studies, retrospective studies, prospective studies of clinical high-risk populations, and exploration of the progression after the first manic episode. Investigations with neuroimaging, cognition assessments, and biomarkers provide promising (although not definitive) evidence of alterations in the neural substrate during the at-risk stage. Research on BD should be expanded to encompass at-risk states and aligned with recent methodological progress in neuroscience.

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Section: Clinical Presentation Of Early Stagesmentioning

confidence: 99%

Section: Retrospective Designsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Challenges and developments in research of the early stages of bipolar disorder

Brietzke

Rosa

Pedrini

et al. 2016

Rev. Bras. Psiquiatr.

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“…In a retrospective chart review study, approximately 23% of individuals in the BAR group developed BD over 8 months. 22 Although these preliminary criteria have recently been validated prospectively by the same group, 26 more research is needed to validate and refine the diagnostic BAR criteria. 24 Although research for this purpose is underway, there is also increasing experimental interest in developing and evaluating interventions that can be delivered before the initial onset of manic or psychotic symptoms to slow or prevent illness progression in highrisk populations.…”

Section: Prodromal Period Of First Manic Episode (Stage I)mentioning

confidence: 99%

“…[22][23][24] The paradigm of early intervention in this disorder has led to the spread of mental health services focused on early psychosis, an initiative shown to lead to more favorable long-term outcomes and that is cost-effective. 25,26 The objective of this study was to review the literature related to the characterization of the early stages of BD, defined as the clinical prodrome/subsyndromal stage and first-episode phase, and to their respective treatment.…”

Section: Introductionmentioning

confidence: 99%

Early stages of bipolar disorder: characterization and strategies for early intervention

Rios

Noto

Rizzo

et al. 2015

Rev. Bras. Psiquiatr.

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Objective: To characterize the early stages of bipolar disorder (BD), defined as the clinical prodrome/ subsyndromal stage and first-episode phase, and strategies for their respective treatment. Methods: A selective literature search of the PubMed, Embase, PsycINFO, and ISI databases from inception until March 2014 was performed. Included in this review were articles that a) characterized prodromal and first-episode stages of BD or b) detailed efficacy and safety/tolerability of interventions in patients considered prodromal for BD or those with only one episode of mania/hypomania. Results: As research has only recently focused on characterization of the early phase of BD, there is little evidence for the effectiveness of any treatment option in the early phase of BD. Case management; individual, group, and family therapy; supportive therapy; and group psychoeducation programs have been proposed. Most evidence-based treatment guidelines for BD do not address treatment specifically in the context of the early stages of illness. Evidence for pharmacotherapy is usually presented in relation to illness polarity (i.e., manic/mixed or depressed) or treatment phase. Conclusions: Although early recognition and treatment are critical to preventing unfavorable outcomes, there is currently little evidence for interventions in these stages of BD.

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Bipolar At-Risk Criteria and Risk of Bipolar Disorder Over 10 or More Years

Ratheesh,

Hammond,

Watson

et al. 2023

JAMA Netw Open

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ImportancePredicting the onset of bipolar disorder (BD) could facilitate preventive treatments. Among risk measures, bipolar at-risk (BAR) criteria have shown promise in predicting onset of bipolar disorder in the first year in clinical cohorts; however, it is not known whether BAR criteria are associated with the onset of BD in the longer term.ObjectiveTo assess the association of BAR criteria with onset of BD over 10 to 13 years follow-up.Design, Setting, and ParticipantsThis prospective cohort study, completed between May 1, 2020, and November 7, 2022, included consenting people seeking help for nonpsychotic major mental health difficulties, including mood, personality, and substance use disorders, who were originally recruited at ages 15 to 25 years from a tertiary youth mental health setting in metropolitan Melbourne, Victoria, Australia, from May 1, 2008, to September 30, 2010.ExposureMeeting BAR criteria at baseline. Criteria included subthreshold mania, cyclothymic features, subthreshold depression, and family history of BD. A matched clinical comparison group was recruited from the same help-seeking population.Main Outcomes and MeasuresThe primary outcome was expert consensus diagnosis of BD I or II based on the Mini International Neuropsychiatric Interview, self-reported information collected through online assessments, and linked data on mental health service utilization in Victoria over 10 to 13 years of follow-up.ResultsAmong 69 eligible participants, follow-up data were available for 60 (88.2%). The mean (SD) age at the end of follow-up was 32.9 (2.8) years, and 49 (81.7%) were women. A total of 28 participants met BAR criteria, and 32 were in the comparison group. In the BAR group, 8 patients (28.6%) developed BD over a mean (SD) of 11.1 (0.7) years of follow-up, and no patients in the comparison group developed BD. The risk of developing BD was higher in the BAR group than in the non-BAR group (χ21 = 70.0; P &lt; .001). The proportions of transitions to BD were equal in the first and second halves of the follow-up period.Conclusions and relevanceIn this cohort study of participants seeking care for mental health difficulties, patients meeting the BAR criteria were significantly more likely to transition to BD over a decade after ascertainment compared with patients not meeting the BAR criteria. The findings suggest that those meeting BAR criteria may benefit from longer-term monitoring and support. Evaluation of predictive properties in longer-term studies using a risk measure will help with implementation of BAR criteria in clinical settings.

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The predictive validity of bipolar at‐risk (prodromal) criteria in help‐seeking adolescents and young adults: a prospective study

Abstract: These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.

Cited by 112 publications

References 50 publications

Challenges and developments in research of the early stages of bipolar disorder

Challenges and developments in research of the early stages of bipolar disorder

Early stages of bipolar disorder: characterization and strategies for early intervention

Bipolar At-Risk Criteria and Risk of Bipolar Disorder Over 10 or More Years

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