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“The quantification of an individual’s risk could inform treatment decisions, such as the use and specific choice of antidepressant medications for a depressed BP-NOS [bipolar disorder–not otherwise specified] youth at high risk for conversion vs. a depressed BP-NOS youth at low risk for conversion,” wrote Boris Birmaher, M.D., of the University of Pittsburgh School of Medicine and colleagues. “Moreover, quantification of an individual’s risk will enable the youth (and the family) to more accurately understand his/her own level of risk, which may in turn have a positive effect on treatment engagement and adherence.”
Birmaher and colleagues selected predictor variables for the risk calculator based on the results of a recent meta-analysis that identified common prodromal symptoms in individuals who later developed bipolar disorder. The final calculator included mood-related scores on the K-SADS Kiddie Mania Rating Scale and Kiddie Depression Rating Scale, as well as scores on the Screen for Child Anxiety Related Emotional Disorders, Behavior Control Scale, and Children’s Global Assessment Scale. Family history of mania, duration of subthreshold symptoms, and demographic factors including age, sex, and race were also incorporated.
The researchers tested this calculator on 140 youth aged 6 to 17 who were part of a long-term bipolar disorder study. All the youth had subthreshold bipolar symptoms (known as bipolar disorder–not otherwise specified [BP-NOS] in DSM-IV). These youth were assessed every seven months for about 11.5 years; 75 of the youth converted to either bipolar I or bipolar II disorder, 57 of whom converted within five years. The risk calculator could discriminate those youth who did or did not convert with around 71% accuracy overall (74% accuracy for bipolar I and 70% for bipolar II). This prediction rate is comparable to the performance of recently developed risk calculators for psychosis.
The researchers then validated the calculator in a second, independent cohort of 58 BP-NOS youth, and the calculator predicted five-year bipolar conversion with 75% accuracy, suggesting the calculator is generalizable to other samples of patients.
“If replicated, the risk calculator provided in this study offers a useful tool for clinicians to predict an individual’s child’s risk of converting from subsyndromal mania to BP-I/II, and thus inform personalized treatment decisions,” the authors wrote.
To read more about risk calculators, see the Psychiatric News article “Multimodal Approach May Improve Ability to Predict Transition to Psychosis.”
(Image: iStock/izusek)
