Bipolar at-risk criteria: an examination of which clinical features have optimal utility for identifying youth at risk of early transition from depression to bipolar disorders

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Scott, Jan, Marwaha, Steven, Ratheesh, Aswin, Macmillan, Iain, Yung, Alison R., Morriss, Richard K., Hickie, Ian B. and Bechdolf, Andreas (2017) Bipolar at-risk criteria: an examination of which clinical features have optimal utility for identifying youth at risk of early transition from depression to bipolar disorders. Schizophrenia Bulletin, 43 (4). pp. 737-744. ISSN 1745-1701

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Abstract

Background: A clinical and research challenge is to identify which depressed youth are at risk of “early transition to bipolar disorders (ET-BD).” This 2-part study (1) examines the clinical utility of previously reported BD at-risk (BAR) criteria in differentiating ET-BD cases from unipolar depression (UP) controls; and (2) estimates the Number Needed to Screen (NNS) for research and general psychiatry settings.

Methods: Fifty cases with reliably ascertained, ET-BD I  and II cases were matched for gender and birth year with 50 UP controls who did not develop BD over 2 years. We estimated the clinical utility for finding true cases and screening out non-cases for selected risk factors and their NNS. Using a convenience sample (N = 80), we estimated the NNS when adjustments were made to account for data missing from clinical case notes.

Results: Sub-threshold mania, cyclothymia, family history of BD, atypical depression symptoms and probable antidepressant-emergent elation, occurred significantly more frequently in ET-BD youth. Each of these “BARDepression” criteria demonstrated clinical utility for screening out non-cases. Only cyclothymia demonstrated good utility for case finding in research settings; sub-threshold mania showed moderate utility. In the convenience sample, the NNS for each criterion ranged from ~4 to 7. 

Conclusions: Cyclothymia showed the optimum profile for case finding, screening and NNS in research settings. However, its presence or absence was only reported in 50% of case notes. Future studies of ET-BD instruments should distinguish which criteria have clinical utility for case finding vs screening.

Item Type: Article
RIS ID: https://nottingham-repository.worktribe.com/output/869917
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Schizphrenia Bulletin following peer review. The version of record Jan Scott, Steven Marwaha, Aswin Ratheesh, Iain Macmillan, Alison R Yung, Richard Morriss, Ian B Hickie, Andreas Bechdolf; Bipolar At-Risk Criteria: An Examination of Which Clinical Features Have Optimal Utility for Identifying Youth at Risk of Early Transition From Depression to Bipolar Disorders, Schizophrenia Bulletin, Volume 43, Issue 4, 1 July 2017, Pages 737–744, https://doi.org/10.1093/schbul/sbw154 is available online at: https://academic.oup.com/schizophreniabulletin/article/2548997
Keywords: screening, case finding, youth, bipolar fdisorderm ultra-high risk, at risk criteriam validity, clinical utility index, number needed to screen
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine
Identification Number: https://doi.org/10.1093/schbul/sbw154
Depositing User: Eprints, Support
Date Deposited: 10 Jan 2017 15:18
Last Modified: 04 May 2020 18:52
URI: https://eprints.nottingham.ac.uk/id/eprint/39739

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