Wednesday, January 29, 2020

Risk Calculator Predicts Youth Likely to Experience Recurrence of Bipolar Symptoms

It is possible to predict whether youth with a history of bipolar disorder will experience a recurrence of symptoms using a risk calculator that factors in patient characteristics commonly measured in clinical practice.

That’s the finding from a report that appears in the Journal of the American Academy of Child and Adolescent Psychiatry. “The risk calculator offers a potentially useful clinical and research tool to predict the individual progression of the illness and guide treatment,” wrote Boris Birmaher, M.D., of the University of Pittsburgh School of Medicine and colleagues.

The researchers created a bipolar relapse risk calculator that assessed 11 potential predictors of symptom recurrence, based on existing scientific literature. These predictors included a patient’s age and family history, severity of previous mood episode of illness, length of time of recovery since last mood episode, and more.

They used this risk calculator to assess 363 youth (mean age 13 years) with a history of bipolar disorder who were currently in recovery (defined as at least two months with no or minimal mood symptoms). The researchers evaluated any changes in the participants’ psychiatric symptoms on average every seven months for a median of 12.5 years.

Over the course of the study, approximately 80% of participants had at least one recurrence of depressive or manic symptoms and 60% had two or more recurrences. The risk calculator was able to predict which youth would experience a mood recurrence within six months or five years with 72% and 82% accuracy, respectively. The calculator was slightly better at predicting future hypomania compared with future depression. The most important factors in predicting recurrence of mood episodes were shorter periods of recovery, younger age at assessment, earlier mood onset, and history of more severe depression.

“A clinician could utilize the risk calculator … to predict the person-level risk for recurrences [whether depressive or hypomanic] at different points of time after recovery,” Birmaher and colleagues wrote. “This information can inform the management of individual patients and is valuable for the patients and their families to enhance their understanding of illness prognosis and become more involved in their treatment. For example, a high-risk score may indicate the need for more frequent follow-ups, and more intensive treatment to avoid recurrences.”

For related information, see the Psychiatric News article “Preventing and Treating Mood Disorders Starting in Childhood.”

(Image: iStock/Chinnapong)

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