Progression along the bipolar spectrum: A longitudinal study of predictors of conversion from bipolar spectrum conditions to bipolar I and II disorders.

Abstract

Little longitudinal research has examined progression to more severe bipolar disorders in individuals with “soft” bipolar spectrum conditions. We examine rates and predictors of progression to bipolar I and II diagnoses in a non-patient sample of college-age participants (n = 201) with high General Behavior Inventory scores and childhood or adolescent onset of “soft” bipolar spectrum disorders followed longitudinally for 4.5 years from the Longitudinal Investigation of Bipolar Spectrum (LIBS) project. Of 57 individuals with initial cyclothymia or bipolar disorder not otherwise specified (BiNOS) diagnoses, 42.1% progressed to a bipolar II diagnosis and 10.5% progressed to a bipolar I diagnosis. Of 144 individuals with initial bipolar II diagnoses, 17.4% progressed to a bipolar I diagnosis. Consistent with hypotheses derived from the clinical literature and the Behavioral Approach System (BAS) model of bipolar disorder, and controlling for relevant variables (length of follow-up, initial depressive and hypomanic symptoms, treatment-seeking, and family history), high BAS sensitivity (especially BAS Fun Seeking) predicted a greater likelihood of progression to bipolar II disorder, whereas early age of onset and high impulsivity predicted a greater likelihood of progression to bipolar I (high BAS sensitivity and Fun-Seeking also predicted progression to bipolar I when family history was not controlled). The interaction of high BAS and high Behavioral Inhibition System (BIS) sensitivities also predicted greater likelihood of progression to bipolar I. We discuss implications of the findings for the bipolar spectrum concept, the BAS model of bipolar disorder, and early intervention efforts.

Instruments that prospectively predict bipolar disorder – A systematic review

“…Targeted populations: Two studies involved recruitment of university students (Alloy et al, 2012;Kwapil et al, 2000), two had samples drawn from the general population (Axelson et al, 2011;Papachristou et al, 2013) and two studies recruited offspring of affectively ill parents (Meyer et al, 2009;Reichart et al, 2005). Only one study focused on clinically symptomatic individuals at baseline (Axelson et al, 2011).…”

“…The follow-up period varied from 4.5 (Alloy et al, 2012) to 23 years (Meyer et al, 2009). Quality of instruments: All studies achieved an overall quality rating of B or C (Table 3).…”

“…Studies or sub-samples were excluded when BD I or II were included in the baseline sample and it was not possible to exclude data for these participants (Alloy et al, 2012;Arrasate et al, 2013). Two authors (AR, SC) confirmed decisions about eligibility when there was doubt about the interpretation of inclusion and exclusion criteria.…”

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

“…The issue is further compounded by uncertainty regarding the diagnostic stability of BSDs. In fact, BSDs may be prodromal to BD I and BD II in a substantial number of patients, according to one longitudinal study of 57 people with cyclothymia or BD NOS, where 42% progressed to BD II and 10% to BD I over a 4.5-year follow-up period (361).…”

Bipolar affective disorders: the specific features of the course and maintenance pharmacotherapy

“…В литературе описана и возможность перехода от мо-нополярного к биполярному течению [3,25]. Около 20% ре-куррентных депрессий трансформируется в БАР.…”