Predicting Personalized Risk of Mood Recurrences in Youths and Young Adults With Bipolar Spectrum Disorder

Abstract

Objective: With each recurrence the prognosis of bipolar disorder (BD) worsens, indicating the need to identify the factors associated with increased recurrence risk. The course of BD is heterogenous and although risk factors for recurrence for the group as a whole have been reported in the literature, identification of risk factors for a specific individual are crucial for developing personalized treatments.Method: 363 recovered BD youths/young adults from the Course and Outcome of Bipolar Youth (COBY) study were included. Participants were evaluated on average every 7-months for a median of 12.5 years and interviewed with standard instruments.

A risk calculator to predict suicide attempts among individuals withearly‐onsetbipolar disorder

“…The RC was trained via boosted multinomial classification trees, 29 a useful model for these data because it implicitly incorporates interactions between predictors and has been shown to effectively predict mood episodes in COBY and elsewhere 17,30 . Predictions were then calibrated via Platt scaling 31 .…”

“…Recently, RCs have been developed to predict course and treatment response in psychiatric disorders including psychosis 11 and depression 14 . Our group developed RCs to predict 5‐year bipolar disorder onset among offspring of parents with bipolar disorder, 15 risk for progression from bipolar, not otherwise specified (NOS), to bipolar‐I/‐II among youth, 16 and risk for mood recurrence among young adults with bipolar disorder 17 …”

“…14 Our group developed RCs to predict 5-year bipolar disorder onset among offspring of parents with bipolar disorder, 15 risk for progression from bipolar, not otherwise specified (NOS), to bipolar-I/-II among youth, 16 and risk for mood recurrence among young adults with bipolar disorder. 17 Efforts to create RCs to predict individual-level risk for suicide attempt have been limited to date. Spittal et al 18 developed the 4-item Repeated Episodes of Self-Harm (RESH) scale to predict 6-month risk of self-harm repetition (with or without suicidal intent) among hospitalized individuals, with AUC = 0.75.…”

Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

“…Although the course BD is heterogeneous, in a substantial group of patients, the risk of recurrence increases with the number of previous episodes. 53 , 143 Overall, the model of staging has helped clinicians to appreciate the importance of early identification and treatment in BD. 144 Models of staging do not imply a uniform or inevitable progression from less severe to more complicated presentations.…”

Prospectively ascertained mania and hypomania among young adults with child‐ and adolescent‐onset bipolar disorder

“…Previous COBY analyses assessed differences between youth with child‐ and adolescent‐onset BD at intake and found that youth with child‐onset (vs. adolescent‐onset) BD had higher levels of mood liability during manic/hypomanic episodes, higher rates of attention deficit hyperactivity disorder (ADHD) and lower rates of substance use disorder (SUD), and higher rates of family history of both mood and non‐mood psychopathology 15,16 . While analyses from the COBY study indicate that mood symptoms in general persist into young adulthood for these youth, 17,18 the presence versus absence of mania/hypomania in young adulthood, and how this may differ for youth with child‐ versus adolescent‐onset mania/hypomania, have not been directly assessed. In fact, to our knowledge, there have not been any clinical studies to prospectively assess the continuity of mania/hypomania across childhood, adolescence, and young adulthood.…”