title: Bipolar At-Risk Criteria: An Examination of Which Clinical Features Have Optimal Utility for Identifying Youth at Risk of Early Transition From Depression to Bipolar Disorders.
abstract: A clinical and research challenge is to identify which depressed youth are at risk of "early transition to bipolar disorders (ET-BD)." This 2-part study (1) examines the clinical utility of previously reported BD at-risk (BAR) criteria in differentiating ET-BD cases from unipolar depression (UP) controls; and (2) estimates the Number Needed to Screen (NNS) for research and general psychiatry settings.
  
  
  
  Fifty cases with reliably ascertained, ET-BD I and II cases were matched for gender and birth year with 50 UP controls who did not develop BD over 2 years. We estimated the clinical utility for finding true cases and screening out non-cases for selected risk factors and their NNS. Using a convenience sample (N = 80), we estimated the NNS when adjustments were made to account for data missing from clinical case notes.
  
  
  
  Sub-threshold mania, cyclothymia, family history of BD, atypical depression symptoms and probable antidepressant-emergent elation, occurred significantly more frequently in ET-BD youth. Each of these "BAR-Depression" criteria demonstrated clinical utility for screening out non-cases. Only cyclothymia demonstrated good utility for case finding in research settings; sub-threshold mania showed moderate utility. In the convenience sample, the NNS for each criterion ranged from ~4 to 7.
  
  
  
  Cyclothymia showed the optimum profile for case finding, screening and NNS in research settings. However, its presence or absence was only reported in 50% of case notes. Future studies of ET-BD instruments should distinguish which criteria have clinical utility for case finding vs screening.
authors.affiliation: Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.|IPPN, King's College, London, UK.
authors.forename: Jan
authors.initials: J
authors.lastname: Scott
authors.affiliation: Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Marwaha
authors.affiliation: Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia.|Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.
authors.forename: Aswin
authors.initials: A
authors.lastname: Ratheesh
authors.affiliation: Early Intervention in Psychosis Service, NTW NHS Trust, Newcastle upon Tyne, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Macmillan
authors.affiliation: Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.|Greater Manchester West NHS Mental Health Foundation Trust, Manchester, UK.
authors.forename: Alison R
authors.initials: AR
authors.lastname: Yung
authors.affiliation: Institute of Mental Health, University of Nottingham, Nottingham, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Morriss
authors.affiliation: Brain and Mind Centre, The University of Sydney, Sydney, Australia.
authors.forename: Ian B
authors.initials: IB
authors.lastname: Hickie
authors.affiliation: Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia.|Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.|Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, and Academic Hospital of Charity Medicine, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bechdolf
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000503:physiopathology*; D016022:Case-Control Studies; D002648:Child; D003527:Cyclothymic Disorder / Q000175:diagnosis / Q000503:physiopathology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D012306:Risk; D055815:Young Adult
keywords: at-risk criteria; bipolar disorder; case finding; clinical utility index; number needed to screen; screening; ultra-high risk; validity; youth