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
Background: 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 depress...
| Main Authors: | , , , , , , , |
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| Format: | Article |
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Oxford University Press
2017
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| Online Access: | https://eprints.nottingham.ac.uk/39739/ |
| _version_ | 1848795902429364224 |
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| author | Scott, Jan Marwaha, Steven Ratheesh, Aswin Macmillan, Iain Yung, Alison R. Morriss, Richard K. Hickie, Ian B. Bechdolf, Andreas |
| author_facet | Scott, Jan Marwaha, Steven Ratheesh, Aswin Macmillan, Iain Yung, Alison R. Morriss, Richard K. Hickie, Ian B. Bechdolf, Andreas |
| author_sort | Scott, Jan |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background: 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.
Methods: 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.
Results: 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 “BARDepression” 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.
Conclusions: 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. |
| first_indexed | 2025-11-14T19:39:28Z |
| format | Article |
| id | nottingham-39739 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:39:28Z |
| publishDate | 2017 |
| publisher | Oxford University Press |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-397392020-05-04T18:52:55Z https://eprints.nottingham.ac.uk/39739/ 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 Scott, Jan Marwaha, Steven Ratheesh, Aswin Macmillan, Iain Yung, Alison R. Morriss, Richard K. Hickie, Ian B. Bechdolf, Andreas Background: 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. Methods: 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. Results: 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 “BARDepression” 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. Conclusions: 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. Oxford University Press 2017-07-01 Article PeerReviewed Scott, Jan, Marwaha, Steven, Ratheesh, Aswin, Macmillan, Iain, Yung, Alison R., Morriss, Richard K., Hickie, Ian B. and Bechdolf, Andreas (2017) 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. Schizophrenia Bulletin, 43 (4). pp. 737-744. ISSN 1745-1701 screening case finding youth bipolar fdisorderm ultra-high risk at risk criteriam validity clinical utility index number needed to screen https://academic.oup.com/schizophreniabulletin/article/2548997 doi:10.1093/schbul/sbw154 doi:10.1093/schbul/sbw154 |
| spellingShingle | screening case finding youth bipolar fdisorderm ultra-high risk at risk criteriam validity clinical utility index number needed to screen Scott, Jan Marwaha, Steven Ratheesh, Aswin Macmillan, Iain Yung, Alison R. Morriss, Richard K. Hickie, Ian B. Bechdolf, Andreas 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 |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | screening case finding youth bipolar fdisorderm ultra-high risk at risk criteriam validity clinical utility index number needed to screen |
| url | https://eprints.nottingham.ac.uk/39739/ https://eprints.nottingham.ac.uk/39739/ https://eprints.nottingham.ac.uk/39739/ |