An International Society of Bipolar Disorders task force report: Precursors and prodromes of bipolar disorder

Faedda, Gianni L.; Baldessarini, Ross J.; Marangoni, Ciro; Bechdolf, Andreas; Berk, Michael; Birmaher, Boris; Conus, Philippe; DelBello, Melissa P.; Duffy, Anne; Hillegers, Manon H. J.; Pfennig, Andrea; Post, Robert M.; Preisig, Martin; Ratheesh, Aswin; Salvatore, Paola; Tohen, Mauricio; Vázquez, Gustavo; Vieta, Eduard; Yatham, Lakshmi N.; Youngstrom, Eric A.; Meter, Anna Van; Correll, Christoph U.

doi:10.1111/bdi.12831

Cited by 80 publications

(61 citation statements)

References 138 publications

(263 reference statements)

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“…In addition to severity of depression, patients with moderate and severe psychiatric disturbance during UD had an approximately twofold higher risk for conversion to BD than patients with mild disturbance. Furthermore, as in earlier studies, 9 we found patients with recurrent (previously non-hospitalized) depression to beat higher risk of converting to BD than patients with a single episode. As in the study of the Danish group, females were at higher risk of conversion to BD than males.…”

Section: Predictors For Diagnostic Conversionsupporting

confidence: 88%

“…6 Although early diagnosis and treatment of these disorders would significantly reduce their enormous burden, apparent phenomenological similarity in the prodromal phases and clinicians' limited ability to predict the development of psychopathology on the individual level often challenge recognition of the major psychiatric disorders in clinical practice. Depressive symptoms and syndromes are common at the initial stages of both BD [7][8][9] and psychotic disorders. 10,11 As BD and schizophrenia differ in their prognosis and treatment approaches, knowing how commonly patients initially diagnosed with UD will subsequently convert to BD and psychotic disorders, when the diagnostic conversion will commonly occur, and what factors predict the conversion are critical for identifying depressed patients at risk.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15‐year register study on 43 495 inpatients

et al. 2020

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Objective To examine temporal patterns and predictors for diagnostic conversion from unipolar depression (UD) to bipolar disorder (BD), schizophrenia, and schizoaffective disorder (SAD). Methods A prospective nationwide register‐based cohort (n = 43 495) of all first psychiatric hospitalizations due to UD during 1996‐2011 was followed up to 15 years. We used cumulative incidence function (CIF) analyses and the Fine‐Gray subdistribution model to define the cumulative incidence of the conversions and subdistribution hazard ratios (SHRs) for predictors. Results The overall 15‐year cumulative incidence of conversion was 11.1% (95% CI 10.7‐11.6): 7.4% (95% CI 7.0‐7.8) for BD, 2.5% (95% CI 2.3‐2.7) for schizophrenia, and 1.3% (95% CI 1.1‐1.4) for SAD. The highest crude incidence rate emerged during the first year. Psychotic depression predicted higher conversion risk to BD (SHR = 2.0, 95% CI 1.5‐2.7), schizophrenia (SHR = 5.3, 95% CI 3.3‐8.7), and SAD (SHR = 10.6, 95% CI 4.0‐28.4) than mild depression. Female sex, greater overall disturbance, and comorbid personality disorder predicted conversion to BD, whereas young age and male sex to psychotic disorders. Conclusions Among patients with first hospitalization due to UD, approximately one in nine converts to another major psychiatric disorder during 15 years, with the highest risk occurring within the first year. Patients with psychotic depression are particularly vulnerable for conversion to other major psychiatric disorders. Conversion to psychotic disorders occurs earlier than to BD. Males are at higher risk for progression to psychotic disorders, whereas females, patients with recurrent depressive episodes, severe disturbance of overall functioning, and personality disorder are at higher risk for converting to BD.

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Section: Predictors For Diagnostic Conversionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15‐year register study on 43 495 inpatients

et al. 2020

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“…These staging models, based on the hypothesis of neuroprogression in mental disorders, establish a basis for therapeutic intervention strategies in the different illness stages, including the early ones [13]. Evidence suggests the existence of a period of subthreshold and nonspecific symptoms (prodrome) before the full manifestation of the illness [14]. The most replicated finding to date has been the presence of subthreshold manic symptoms prior to the first full-blown manic episode [15].…”

Section: Introductionmentioning

confidence: 99%

Risk Calculators in Bipolar Disorder: A Systematic Review

et al. 2020

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Introduction: Early recognition of bipolar disorder improves the prognosis and decreases the burden of the disease. However, there is a significant delay in diagnosis. Multiple risk factors for bipolar disorder have been identified and a population at high-risk for the disorder has been more precisely defined. These advances have allowed the development of risk calculators to predict individual risk of conversion to bipolar disorder. This review aims to identify the risk calculators for bipolar disorder and assess their clinical applicability. Methods: A systematic review of original studies on the development of risk calculators in bipolar disorder was performed. The studies’ quality was evaluated with the Newcastle-Ottawa Quality Assessment Form for Cohort Studies and according to recommendations of the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis Initiative. Results: Three studies met the inclusion criteria; one developed a risk calculator of conversion from major depressive episode to bipolar disorder; one of conversion to new-onset bipolar spectrum disorders in offspring of parents with bipolar disorder; and the last one of conversion in youths with bipolar disorder not-otherwise-specified. Conclusions: The calculators reviewed in this article present good discrimination power for bipolar disorder, although future replication and validation of the models is needed.

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“…In a recent task force report of the International Society of Bipolar Disorders potential precursors of BD in patients with and without positive family history from prospective and retrospective studies are described, and the need for early recognition with the assessment of the many risk factors emphasized 30 …”

Section: Introductionmentioning

confidence: 99%

Efficacy of cognitive‐behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study

et al. 2020

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Objective Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at‐risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive‐behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms. Method In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15‐30 years were randomized to 14 weeks of at‐risk for BD‐specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14 weeks. At‐risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample. Results Of 128 screened participants, 75 were randomized to group CBT (n = 38, completers = 65.8%) vs unstructured group meetings (n = 37, completers = 78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P < .001) and during 6 months (P < .001) in both groups, without significant between‐group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop‐outs. Conclusions Results suggest that young patients at‐risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification.

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An International Society of Bipolar Disorders task force report: Precursors and prodromes of bipolar disorder

Abstract: This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 80 publications

References 138 publications

Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15‐year register study on 43 495 inpatients

Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15‐year register study on 43 495 inpatients

Risk Calculators in Bipolar Disorder: A Systematic Review

Efficacy of cognitive‐behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study

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