title: The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: a prospective study.
abstract: OBJECTIVE
  There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria.
  
  
  METHODS
  This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15-24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania.
  
  
  RESULTS
  A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ(2) (1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder.
  
  
  CONCLUSIONS
  These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.
authors.affiliation: Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban, Academic Hospital of Charite Medicine Berlin, Berlin, Germany; Orygen Youth Health Research Centre; Centre for Youth Mental Health, University of Melbourne, Parkville, Vic., Australia; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bechdolf
authors.forename: Aswin
authors.initials: A
authors.lastname: Ratheesh
authors.forename: Sue M
authors.initials: SM
authors.lastname: Cotton
authors.forename: Barnaby
authors.initials: B
authors.lastname: Nelson
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Chanen
authors.forename: Jennifer
authors.initials: J
authors.lastname: Betts
authors.forename: Tiffany
authors.initials: T
authors.lastname: Bingmann
authors.forename: Alison R
authors.initials: AR
authors.lastname: Yung
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001315:Australia; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D062706:Prodromal Symptoms; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000592:standards; D015203:Reproducibility of Results; D012307:Risk Factors; D055815:Young Adult
keywords: bipolar disorder; cyclothymia; depression; follow-up; high-risk; mania; prodrome; prospective study