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
Alison R. Yung
Richard K. Morriss
Ian B. Hickie
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.
|Journal Article Type||Article|
|Publication Date||Jul 1, 2017|
|Publisher||Oxford University Press|
|Peer Reviewed||Peer Reviewed|
|APA6 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), doi: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|
|Copyright Statement||Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf|
|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.co...ulletin/article/2548997|
final revised main text submission copy scott BAR aug 2016.pdf
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf
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