A preliminary evaluation of the validity of at-risk criteria for bipolar disorders in help-seeking adolescents and young adults

J Affect Disord. 2010 Dec;127(1-3):316-20. doi: 10.1016/j.jad.2010.06.016. Epub 2010 Jul 8.


Introduction: We have developed ultra-high risk criteria for bipolar affective disorder (bipolar at-risk - BAR) which include general criteria such as being in the peak age range of the onset of the disorder and a combination of specific criteria including sub-threshold mania, depressive symptoms, cyclothymic features and genetic risk. In the current study, the predictive validity of these criteria were tested in help-seeking adolescents and young adults.

Method: This medical file-audit study was conducted at ORYGEN Youth Health (OYH), a public mental health program for young people aged between 15 and 24years and living in metropolitan Melbourne, Australia. BAR criteria were applied to the intake assessments of all non-psychotic patients who were being treated in OYH on 31 January, 2008. All entries were then checked for conversion criteria. Hypomania/mania related additions or alterations to existing treatments or initiation of new treatment by the treating psychiatrist served as conversion criteria to mania.

Results: The BAR criteria were applied to 173 intake assessments. Of these, 22 patients (12.7%) met BAR criteria. The follow-up period of the sample was 265.5days on average (SD 214.7). There were significantly more cases in the BAR group (22.7%, n=5) than in the non-BAR group (0.7%, n=1) who met conversion criteria (p<.001).

Conclusions: These findings support the notion that people who develop a first episode of mania can be identified during the prodromal phase. The proposed criteria need further evaluation in prospective clinical trials.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / genetics
  • Bipolar Disorder / psychology
  • Community Mental Health Services
  • Early Diagnosis
  • Female
  • Genetic Predisposition to Disease / genetics
  • Humans
  • Male
  • Mass Screening
  • Medical Audit
  • Patient Acceptance of Health Care / psychology*
  • Personality Assessment / statistics & numerical data*
  • Psychometrics / statistics & numerical data
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Victoria
  • Young Adult