title: Candidate Risks Indicators for Bipolar Disorder: Early Intervention Opportunities in High-Risk Youth.
abstract: BACKGROUND
  Psychiatric illnesses like bipolar disorder are increasingly understood to be neurodevelopmental disorders with clinical, psychological, and biological indicators recognizable long before the emergence of the full-blown syndromes.
  
  
  METHODS
  This paper is a selective review of findings from studies of high-risk children of affected parents that inform the knowledge of illness risk and development markers of bipolar disorder. We specifically focus on candidate clinical, biological, and psychological risk indicators that could serve as targets for future early intervention and prevention studies.
  
  
  RESULTS
  There is convergent evidence from prospective studies that bipolar disorder typically debuts as depressive episodes after puberty. In some high-risk children, sleep and anxiety disorders precede mood disorders by several years and reflect an increased vulnerability. An association between early exposure to adversity (eg, exposure to parental illness, neglect from mother) and increased risk of psychopathology may be mediated through increased stress reactivity evident at both behavioral and biological levels. Inter-related psychological processes including reward sensitivity, unstable self-esteem, rumination, and positive self-appraisal are risk factors for mood disorders. Disturbances in circadian rhythm and immune dysfunction are associated with mood disorders and may be vulnerability markers influenced by these other risk factors.
  
  
  CONCLUSIONS
  There is accruing evidence of a number of measurable and potentially modifiable markers of vulnerability and developing illness in youth at familial risk for bipolar disorder. Longitudinal studies of multiple biological and psychological risk processes in high-risk offspring, both individually and together, will improve our understanding of illness onset and lead to the development of specific early interventions.
authors.affiliation: Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Dr Duffy); Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada (Dr Duffy); Lancaster University, Division of Health Research, Lancaster, United Kingdom (Dr Jones); Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Ms Goodday, Dr Bentall); University of Liverpool, Institute of Psychology Health and Society, Liverpool, United Kingdom (Ms Goodday and Dr Bentall). acduffy@ucalgary.ca.
authors.forename: Anne
authors.initials: A
authors.lastname: Duffy
authors.affiliation: Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Dr Duffy); Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada (Dr Duffy); Lancaster University, Division of Health Research, Lancaster, United Kingdom (Dr Jones); Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Ms Goodday, Dr Bentall); University of Liverpool, Institute of Psychology Health and Society, Liverpool, United Kingdom (Ms Goodday and Dr Bentall).
authors.forename: Steven
authors.initials: S
authors.lastname: Jones
authors.affiliation: Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Dr Duffy); Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada (Dr Duffy); Lancaster University, Division of Health Research, Lancaster, United Kingdom (Dr Jones); Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Ms Goodday, Dr Bentall); University of Liverpool, Institute of Psychology Health and Society, Liverpool, United Kingdom (Ms Goodday and Dr Bentall).
authors.forename: Sarah
authors.initials: S
authors.lastname: Goodday
authors.affiliation: Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada (Dr Duffy); Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada (Dr Duffy); Lancaster University, Division of Health Research, Lancaster, United Kingdom (Dr Jones); Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Ms Goodday, Dr Bentall); University of Liverpool, Institute of Psychology Health and Society, Liverpool, United Kingdom (Ms Goodday and Dr Bentall).
authors.forename: Richard
authors.initials: R
authors.lastname: Bentall
mesh_terms: D001714:Bipolar Disorder / Q000517:prevention & control* / Q000523:psychology*; D002648:Child; D002658:Developmental Disabilities / Q000503:physiopathology*; D018479:Early Intervention, Educational; D006801:Humans; D012307:Risk Factors
keywords: biological risk factors; bipolar disorder; early adversity; high-risk; psychological risk factors