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

Scott, Jan; Marwaha, Steven; Ratheesh, Aswin; Macmillan, Iain; Yung, Alison R.; Morriss, Richard K.; Hickie, Ian B.; Bechdolf, Andreas

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.

Citation

Scott, J., Marwaha, S., Ratheesh, A., Macmillan, I., Yung, A. R., Morriss, R. K., …Bechdolf, A. (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), 737-744. https://doi.org/10.1093/schbul/sbw154

• Journal Article Type: Article
• Acceptance Date: Oct 13, 2016
• Online Publication Date: Nov 21, 2016
• Publication Date: Jul 1, 2017
• Deposit Date: Jan 10, 2017
• Publicly Available Date: Jan 10, 2017
• Journal: Schizophrenia Bulletin
• Print ISSN: 0586-7614
• Electronic ISSN: 1745-1701
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 43
• Issue: 4
• Pages: 737-744
• DOI: https://doi.org/10.1093/schbul/sbw154
• Keywords: screening, case finding, youth, bipolar fdisorderm ultra-high risk, at risk criteriam validity, clinical utility index, number needed to screen
• Public URL: https://nottingham-repository.worktribe.com/output/869917
• Publisher URL: https://academic.oup.com/schizophreniabulletin/article/2548997
• 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