Monday, July 10, 2017

Bipolar Risk Calculator Developed for At-Risk Youth

In a study published last week in JAMA Psychiatry, researchers reported the development of a calculator to predict the onset of a bipolar spectrum disorder (BPSD) in at-risk youth.

BPSD was defined under DSM-IV criteria as bipolar I, bipolar II, cyclothymic disorder, or bipolar not otherwise specified.

The BPSD risk calculator was found to be approximately 76% accurate, which is on par with a recently developed risk calculator for new-onset psychosis as well as risk calculators used in other areas of medicine.

“We recognize that replication of these findings is warranted before the risk calculator can be confidently used for clinical decision making,” wrote lead author Danella Hafeman, M.D., Ph.D., of the University of Pittsburgh and colleagues. “In the interim, this risk calculator provides a practical tool for assessing the prognosis [of] and guiding monitoring and early intervention for offspring of parents with BD.”

Hafeman and colleagues built their calculator by incorporating seven commonly occurring risk factors for BPSD that included measures of mood and anxiety, measures of general psychosocial functioning, and age at mood-disorder onset in the parent with bipolar disorder. They then tested their model on youth enrolled in the Pittsburgh Bipolar Offspring Study, a community-based, longitudinal investigation that monitors children of parents with bipolar I or II disorder.

The study encompassed 412 at-risk offspring who had not yet experienced a manic, hypomanic, or mixed episode and included 1,058 clinician visits by these offspring where risk scores were calculated. The researchers found that the risk calculator could discriminate between a converting visit—defined as the patient being diagnosed with a BPSD within five years of the visit—versus a nonconverting visit 76% of the time.

Consistent with existing research, the parental age at mood disorder onset proved to be the most important single predictor of risk among the seven criteria included in the calculator.

“To date, research in youth at familial risk for BD has mainly focused on psychopathology, description of clinical characteristics, and potential risk factors,” wrote Esther Mesman, Ph.D., and Manon Hillegers, M.D., Ph.D., of the University of Utrecht in the Netherlands in an accompanying editorial. “Hafeman and colleagues propose an individual risk calculator for youth at familial risk for BD, an important consideration for the field of BD. Nonetheless, risk assessment is only valuable if early intervention methods and treatments are available, which should be investigated in parallel.”

To read more about this topic, see the Psychiatric News article "Experts Make Case for Lithium in Youth With Bipolar Disorder."


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