A preliminary evaluation of the validity of at-risk criteria for bipolar disorders in help-seeking adolescents and young adults

Bechdolf, Andreas; Nelson, Barnaby; Cotton, Sue; Chanen, Andrew M; Thompson, Andrew; Kettle, Jonathan W. L.; Conus, Philippe; Amminger, G. Paul; Yung, Alison R.; Berk, Michael; McGorry, Patrick D.

doi:10.1016/j.jad.2010.06.016

Cited by 110 publications

(136 citation statements)

References 33 publications

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“…It can last several weeks up to many years before full development of the disorder. 18,27,28 Mood symptoms commonly exhibited by children, adolescents, and young adults in the prodromal period include syndromal and subsyndromal major depressive disorder (MDD), anxiety and episodic subsyndromal manic symptoms, such as sleep disturbances, anger or irritability, increased energy, and rapid mood fluctuations 22 (also termed cyclotaxia). 29,30 Over time, there is a propensity to progression of psychopathology, and symptoms usually become more specific and more similar to those of full BD.…”

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

confidence: 99%

“…The authors proposed to consider that initial phases of BD may feature symptoms that are insufficient in frequency, severity, or duration to characterize the full-blown disease, but that can represent a high risk of transition to BD in a short period of time. 22 The BAR criteria include individuals under the age of 25 years with: 1) subthreshold mania; 2) depression plus cyclothymic features; or 3) depression plus genetic risk. In a retrospective chart review study, approximately 23% of individuals in the BAR group developed BD over 8 months.…”

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

confidence: 99%

“…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%

“…21 In contrast, in the psychosis field, the importance of early intervention is already well established. [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%

“…Patients, caregivers, and medical staff report significant difficulty in identifying the exact moment at which the transition occurs. 22 Therefore, separation between stages I and II, despite its potential clinical utility, should be interpreted as not always clear. Current limitations of this classification include fluctuation in severity of manic symptoms, variability in degree of suffering and functional impairment, and presence of comorbidities that made the diagnosis process more complex.…”

mentioning

confidence: 99%

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

confidence: 99%

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

confidence: 99%

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

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Rios

Noto

Rizzo

et al. 2015

Rev. Bras. Psiquiatr.

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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 positive and negative sleep appraisal measure: Towards a clinical validation of sleep spectrum cognitions

Pearson

Parker

Mansell

2021

Clin Psychology and Psychoth

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Background Sleep disturbance is considered a transdiagnostic process due to high comorbidity with mental health difficulties. In particular, sleep disturbances are a feature of mood disorders. To advance transdiagnostic psychological interventions targeting sleep, the Positive and Negative Sleep Appraisal Measure (PANSAM) was developed. The PANSAM is a theory‐driven measure based on an Integrative Cognitive Sleep Model and proposes that positive and negative sleep appraisals for excessively long and short sleep durations play a key role in the development of insomnia, hypersomnia, and reduced need for sleep. This study evaluated clinical validity of this new measure. Methods Participants were those who met bipolar at risk criteria and bipolar diagnoses (bipolar spectrum group) (N = 22), major depressive disorder (unipolar depression group) (N = 18), and a nonclinical group (N = 22). To compare against previous insomnia and bipolar disorder relevant research, administered measures included the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) and the Hypomanic and Positive Predictions Inventory (HAPPI). Results Analysis of variance (ANOVA) tests revealed that the clinical groups scored significantly higher on the PANSAM. The same was shown for the DBAS and HAPPI. Post hoc analyses showed that the PANSAM scale and subscales had significant correlations with all clinical measures. Effect sizes are reported due to sample size limitations. Conclusion This study has initially validated the PANSAM with clinical populations and highlighted its applicability to a transdiagnostic approach.

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A preliminary evaluation of the validity of at-risk criteria for bipolar disorders in help-seeking adolescents and young adults

Cited by 110 publications

References 33 publications

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

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

The positive and negative sleep appraisal measure: Towards a clinical validation of sleep spectrum cognitions

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