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High risk criteria validated for bipolar disorder

By Jeremy Cockerill | July 26, 2010

Source: MedWire News

Researchers have developed criteria to identify young people at high risk for developing bipolar disorder, based on detecting a combination of sub-threshold mania, depressive symptoms, cyclothymic features, and genetic risk.

In a sample of young people seeking help, those who met these new criteria were around 40-times more likely to develop full-blown bipolar disorder than those who did not.

“Intervening early in the course of bipolar affective disorder, in the prodromal phase, may reduce this personal and economic burden, as this strategy has the potential to delay, lessen the severity of, or even prevent full-blown disorder,” Andreas Bechdolf (ORYGEN Youth Health Melbourne, Victoria, Australia) and colleagues comment in the Journal of Affective Disorders.

The team previously pioneered ultra-high risk (UHR) criteria for psychosis, now relied upon by mental health teams for help-seeking individuals.

Noting that no such criteria have yet been proposed for bipolar disorder, the researchers devised a “bipolar at-risk” (BAR) tool which relied on surveillance of a combination of sub-threshold mania, depressive symptoms, cyclothymic features, and genetic risk in young people aged between 15 and 24 years.

To validate the BAR tool they recruited 173 young people who sought help at ORYGEN Youth Health (OYH), a public mental health program in Melbourne.

Of the cases assessed, 22 (12.7%) met the BAR criteria for at risk status. Patients in the BAR group were younger than those in the non-BAR group (16.6 versus 18.0 years), 65% were female, and most participants (62%) were students and still living with their families (79%).

After following all 173 participants for an average of 265.5 days, six (22.7%) individuals in the BAR group and one person (0.7%) in the non-BAR group converted to full bipolar disorder, defined in this case as hypomania/mania or initiation of treatment (psychopharmacological medication, admission).

Therefore, young people who met the BAR criteria were significantly more likely to develop a full disorder than those who did not, with an odds ratio of 44.

Discussing the findings the researchers note that the BAR-transition rate of 22.8% is “clinically relevant,” being around 100-fold higher than the risk in the general population and around 20 times the risk of patients with unipolar depression.

“Prospective studies in bigger samples and with longer follow-up periods, better controlled antidepressant use and psychometric measures of conversions are warranted to provide further validity of these criteria,” conclude Bechdolf et al.