title: The association between self-reported and clinically determined hypomanic symptoms and the onset of major mood disorders.
abstract: BACKGROUND
  Hypomanic symptoms may be a useful predictor of mood disorder among young people at high risk for bipolar disorder.
  
  
  OBJECTIVE
  To determine whether hypomanic symptoms differentiate offspring of parents with bipolar disorder (high risk) and offspring of well parents (control) and predict the development of mood episodes.
  
  
  METHODS
  High-risk and control offspring were prospectively assessed using semi-structured clinical interviews annually and completed the Hypomania Checklist-32 Revised (HCL-32). Clinically significant sub-threshold hypomanic symptoms (CSHS) were coded.
  
  
  RESULTS
  HCL-32 total and active or elated scores were higher in control compared with high-risk offspring, whereas 14% of high-risk and 0% of control offspring had CSHS. High-risk offspring with CSHS had a fivefold increased risk of developing recurrent major depression (P=0.0002). The median onset of CSHS in high-risk offspring was 16.4 (6-31) years and was before the onset of major mood episodes.
  
  
  CONCLUSIONS
  CSHS are precursors to major mood episodes in high-risk offspring and could identify individuals at ultra-high risk for developing bipolar disorder.
  
  
  BACKGROUND
  None.
  © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
authors.affiliation: , MSc, Department of Epidemiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Sarah Margaret
authors.initials: SM
authors.lastname: Goodday
authors.affiliation: , MPh, MD, Psychiatric University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Preisig
authors.affiliation: , PhD, Psychiatric University Hospital of Lausanne, Lausanne, Switzerland.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Gholamrezaee
authors.affiliation: , PhD, MD, FRCPC, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada, and Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Grof
authors.affiliation: , MD, Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
authors.forename: Jules
authors.initials: J
authors.lastname: Angst
authors.affiliation: , MSc, MD, FRCPC, Mood Disorders Centre of Ottawa, Ottawa, Ontario, Canada, and Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Duffy