New research may lead to a risk calculator that can help predict which young people at risk of bipolar go on to develop either bipolar 1 or bipolar 2. Young people with a history of depression and some features of bipolar (a brief period of being energized, for example, that doesn’t meet criteria for hypomania) are at risk for developing bipolar I or II as they age. Until recently, there has been no good way to quantify the risk. Ways of predicting who will “convert” to a bipolar I or II diagnosis have been developed for the group of at-risk youth as a whole, but these predictors have not been able to discriminate between different types and levels of risk.
A new study has developed a “risk calculator” that can predict which youth are more likely to convert to a full bipolar diagnosis. Researchers followed a group of at risk youth (aged 6 to 17) who were part of a long-term study on bipolar. The participants were assessed every seven months for 11 and a half years. The team was able to develop an assessment protocol that predicted which of the participants would convert from BP-NOS to bipolar I or II with around 71% accuracy overall.
“Based on this risk calculator, an individual with more symptoms (anxiety, mood lability, depressive, and manic symptoms), lower general psychosocial functioning, and whose parent had a younger age at mood disorder onset is at greater risk for developing new-onset BPSD.”
Quantification of risk can be helpful for individuals allowing doctors to target anti-depressants and other interventions more specifically based on a more accurately determined level of risk. “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.” writes Boris Birmaher, M.D. and colleagues, of the University of Pittsburgh School of Medicine.
The risk calculator incorporated scores from standard instruments such as the Kiddie Mania Rating Scale and Kiddie Depression Rating Scale, as well as family history of mania, and demographic factors were also incorporated. As a follow-up, the risk calculator was used on a separate group of youth with sub-threshold manic symptoms. With this group, the conversion to bipolar I or bipolar II was predicted with 75% accuracy. In contrast, research in 2015, reported in Moodsurfing found that reports by parents and by the children themselves may be more helpful in making the original diagnosis of BP-NOS.
If it can be replicated, this risk calculator holds out the promise of more effective personalized treatment decisions for at risk children and youth.
The calculator itself can be found on the Resources page of the University of Pittsburgh Child and Adolescent Bipolar Spectrum Services.
Moodsurfing has highlighted the work of Dr. Birmaher before, as he has a long-standing interest in childhood bipolar and the risks of developing bipolar. This is a developing field, and we will continue to follow research as it happens.
Hafeman DM, Merranko J, Goldstein TR, et al. Assessment of a Person-Level Risk Calculator to Predict New-Onset Bipolar Spectrum Disorder in Youth at Familial Risk. JAMA Psychiatry. 2017;74(8):841–847. doi:10.1001/jamapsychiatry.2017.1763