A preliminary evaluation of the validity of at-risk criteria for bipolar disorders in help-seeking adolescents and young adults.
BACKGROUND
We have developed ultra-high risk criteria for bipolar affective disorder (bipolar at-risk - BAR) which include general criteria such as being in the peak age range of the onset of the disorder and a combination of specific criteria including sub-threshold mania, depressive symptoms, cyclothymic features and genetic risk. In the current study, the predictive validity of these criteria were tested in help-seeking adolescents and young adults.


METHODS
This medical file-audit study was conducted at ORYGEN Youth Health (OYH), a public mental health program for young people aged between 15 and 24years and living in metropolitan Melbourne, Australia. BAR criteria were applied to the intake assessments of all non-psychotic patients who were being treated in OYH on 31 January, 2008. All entries were then checked for conversion criteria. Hypomania/mania related additions or alterations to existing treatments or initiation of new treatment by the treating psychiatrist served as conversion criteria to mania.


RESULTS
The BAR criteria were applied to 173 intake assessments. Of these, 22 patients (12.7%) met BAR criteria. The follow-up period of the sample was 265.5days on average (SD 214.7). There were significantly more cases in the BAR group (22.7%, n=5) than in the non-BAR group (0.7%, n=1) who met conversion criteria (p<.001).


CONCLUSIONS
These findings support the notion that people who develop a first episode of mania can be identified during the prodromal phase. The proposed criteria need further evaluation in prospective clinical trials.
Bechdolf
Andreas
A
ORYGEN Youth Health, Department of Youth Mental Health, University of Melbourne, Australia. andreas.bechdolf@uk-koeln.de
Nelson
Barnaby
B
Cotton
Sue M
SM
Chanen
Andrew
A
Thompson
Andrew
A
Kettle
Jonathan
J
Conus
Phillippe
P
Amminger
G Paul
GP
Yung
Alison R
AR
Berk
Michael
M
McGorry
Patrick D
PD
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D003156:Community Mental Health Services; D042241:Early Diagnosis; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008297:Male; D008403:Mass Screening; D008485:Medical Audit; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010552:Personality Assessment / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D014739:Victoria; D055815:Young Adult