title: Rationale and first results of developing at-risk (prodromal) criteria for bipolar disorder.
abstract: Bipolar affective disorder (BD) is a severe, recurrent and disabling disorder with devastating consequences for individuals, families and society. Although these hazards and costs provide a compelling rationale for development of early detection and early intervention strategies in BD, the development of at-risk criteria for first episode mania is still in an early stage of development. In this paper we review the literature with respect to the clinical, neuroantomical and neuropsychological data, which support this goal. We also describe our recently developed bipolar at-risk criteria (BAR). This criteria comprises the peak age range of the first onset of bipolar disorder, genetic risk, presenting with sub-threshold mania, cyclothymic features or depressive symptoms. An initial pilot evaluation of the BAR criteria in 22 subjects indicated conversion rates to proxies of first-episode mania of 23% within 265 days on average, and high specificity and sensitivity of the criteria. If prospective studies confirm the validity of the BAR criteria, then the criteria would have the potential to open up new avenues of research for indicated prevention in BD and might therefore offer opportunities to ameliorate the severity of, or even prevent BD.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Germany. andreas.bechdolf@uk-koeln.de
authors.forename: A
authors.initials: A
authors.lastname: Bechdolf
authors.forename: A
authors.initials: A
authors.lastname: Ratheesh
authors.forename: S J
authors.initials: SJ
authors.lastname: Wood
authors.forename: T
authors.initials: T
authors.lastname: Tecic
authors.forename: P
authors.initials: P
authors.lastname: Conus
authors.forename: B
authors.initials: B
authors.lastname: Nelson
authors.forename: S M
authors.initials: SM
authors.lastname: Cotton
authors.forename: A M
authors.initials: AM
authors.lastname: Chanen
authors.forename: G P
authors.initials: GP
authors.lastname: Amminger
authors.forename: S
authors.initials: S
authors.lastname: Ruhrmann
authors.forename: F
authors.initials: F
authors.lastname: Schultze-Lutter
authors.forename: J
authors.initials: J
authors.lastname: Klosterkötter
authors.forename: P
authors.initials: P
authors.lastname: Fusar Poli
authors.forename: A R
authors.initials: AR
authors.lastname: Yung
authors.forename: M
authors.initials: M
authors.lastname: Berk
authors.forename: P D
authors.initials: PD
authors.lastname: McGorry
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology*; D042241:Early Diagnosis; D006801:Humans; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D012307:Risk Factors