title: Prospective progression from high-prevalence disorders to bipolar disorder: Exploring characteristics of pre-illness stages.
abstract: BACKGROUND
  Identification of risk factors within precursor syndromes, such as depression, anxiety or substance use disorders (SUD), might help to pinpoint high-risk stages where preventive interventions for Bipolar Disorder (BD) could be evaluated.
  
  
  METHODS
  We examined baseline demographic, clinical, quality of life, and temperament measures along with risk clusters among 52 young people seeking help for depression, anxiety or SUDs without psychosis or BD. The risk clusters included Bipolar At-Risk (BAR) and the Bipolarity Index as measures of bipolarity and the Ultra-High Risk assessment for psychosis. The participants were followed up for 12 months to identify conversion to BD. Those who converted and did not convert to BD were compared using Chi-Square and Mann Whitney U tests.
  
  
  RESULTS
  The sample was predominantly female (85%) and a majority had prior treatment (64%). Four participants converted to BD over the 1-year follow up period. Having an alcohol use disorder at baseline (75% vs 8%, χ(2)=14.1, p<0.001) or a family history of SUD (67% vs 12.5%, χ(2)=6.0, p=0.01) were associated with development of BD. The sub-threshold mania subgroup of BAR criteria was also associated with 12-month BD outcomes. The severity of depressive symptoms and cannabis use had high effects sizes of association with BD outcomes, without statistical significance.
  
  
  CONCLUSIONS
  The small number of conversions limited the power of the study to identify associations with risk factors that have previously been reported to predict BD. However, subthreshold affective symptoms and SUDs might predict the onset of BD among help-seeking young people with high-prevalence disorders.
authors.affiliation: Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia. Electronic address: aswinr@unimelb.edu.au.
authors.forename: Aswin
authors.initials: A
authors.lastname: Ratheesh
authors.affiliation: Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Cotton
authors.affiliation: Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Betts
authors.affiliation: Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chanen
authors.affiliation: Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia.
authors.forename: Barnaby
authors.initials: B
authors.lastname: Nelson
authors.affiliation: Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Davey
authors.affiliation: Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
authors.affiliation: Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; IMPACT Strategic Research Centre, Deakin University, Geelong, Australia; Florey Institute of Neurosciences and Mental Health, Parkville, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.affiliation: Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia; Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban, Charite Medical University, Berlin, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bechdolf
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D062706:Prodromal Symptoms; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology*; D055815:Young Adult
keywords: Anxiety; At-risk; Bipolar; Depression; Prospective; Substance