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The predictive validity of bipolar at-risk (prodromal) criteria in help-seeking adolescents and young adults: a prospective study

journal contribution
posted on 2014-08-01, 00:00 authored by A Bechdolf, A Rateesh, S M Cotton, B Nelson, A Chanen, J Betts, T Bingmann, Alison YungAlison Yung, Michael BerkMichael Berk, P D McGorry

There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria.

This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15–24 years in metropolitan Melbourne, Australia. At intake, BAR screen-positive individuals and a matched group of individuals who did not meet BAR criteria were observed over a period of 12 months. The BAR criteria include general criteria such as being in the peak age range for the onset of the disorder, as well as sub-threshold mania, depression plus cyclothymic features, and depression plus genetic risk. Conversion to first-episode mania/hypomania was defined by the presence of DSM-IV manic symptoms for more than four days, in line with the DSM-IV definition of hypomania/mania.

A total of 559 help-seeking patients were screened. Of the eligible participants, 59 (10.6%) met BAR criteria. Thirty-five participants were included in the BAR group and 35 matched participants were selected to be in the control group. During the follow-up, five BAR patients out of 35 (14.3%) converted to first-episode hypomania/mania as opposed to none in the non-BAR group [χ2(1) = 5.38, p = 0.020]. Four out of these five converters had a DSM-IV diagnosis of bipolar I or bipolar II disorder.

These findings support the possibility of identification of persons prior to the onset of mania/hypomania. The proposed criteria need further evaluation in larger, prospective studies with longer follow-up periods.



Bipolar Disorders: an international journal of psychiatry and neurosciences






493 - 504


John Wiley & Sons


London, Eng.



Publication classification

C Journal article; C1 Refereed article in a scholarly journal

Copyright notice

2014, Wiley-Blackwell