Research reportCharacteristics, symptomatology and naturalistic treatment in individuals at-risk for bipolar disorders: Baseline results in the first 180 help-seeking individuals assessed at the dresden high-risk project
Section snippets
Background
Considering the success of early recognition and intervention programs focusing on prodromal syndromes for psychosis (Correll et al., 2010, Fusar-Poli et al., 2013, McGorry et al., 1996, McGorry et al., 2009, Schultze-Lutter et al., 2008), related, yet different approaches were developed recently to identify prodromal states of bipolar disorders (BD) (Bechdolf et al., 2010, Brietzke et al., 2012b, Conus et al., 2008, Correll et al., 2007b, Leopold et al., 2012).
The diagnosis of bipolar I or II
Methods
The early recognition center at the university hospital in Dresden, Germany, was established for help-seeking young people from the age of 12 until 40 years. Individuals can also be referred to the center by psychologists, psychiatrists or primary care physicians in case of suspected development of BD or psychosis. After a first contact, subjects are assessed by clinical psychologists and psychiatrists with a standardized diagnostic battery, including psychiatric and medical history,
Results
Between May 2009 and June 2012, 284 young individuals had at least one contact with the early recognition center. 180 (63%) individuals (mean age=25.2±6.7 years, 50% female) underwent diagnostic procedures because of undiagnosed but suspected, manifest and/or prodromal psychiatric disorder(s). Out of these 180 individuals, 29 (16%) met criteria for a bipolar at-risk state and completed the entire battery of the complex diagnostic procedures. Except for a significantly younger age in at-risk
Discussion
Major findings of the presented data are that (1) of the young, help-seeking individuals screened at the early recognition center, 16% met criteria for bipolar at-risk state; (2) 93% of those subjects fulfilled criteria for a current and/or life-time diagnosis of a DSM-IV psychiatric disorder other than bipolar disorder; and (3) only 48% had received any kind of treatment before contacting the early recognition center. In all of those cases, treatment decisions were made without
Limitations
The results of the presented analysis have to be interpreted within its limitations. These include the small sample size of BD at-risk individuals, lack of sufficient prospective data to test the sensitivity and specificity of individual risk markers and constellations, and lack of control groups. However, the summarized data provide a basis for further investigation in the nascent area of early identification and prevention of BD before the first full (hypo)manic episode.
Role of funding source
No funding.
Conflict of interest
C.U. Correll has been a consultant and/or advisor to or has received honoraria from: Actelion, Alexza; Bristol-Myers Squibb, Cephalon, Eli Lilly, Genentech, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, Lundbeck, Medavante, Medscape, Merck, Otsuka, Pfizer, ProPhase, Roche, Sunovion, Takeda, Teva, and Vanda. He has received grant support from BMS, Janssen/J&J, and Otsuka.
M. Bauer has received grant/research support from The Stanley Medical Research Institute, NARSAD, Deutsche
Acknowledgment
None.
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2024, European NeuropsychopharmacologyAt-risk symptoms of bipolar disorder in a university student cohort
2018, Psychiatry ResearchCitation Excerpt :These state, trait, and familial characteristics (Scott et al., 2017) can be monitored prospectively through a critical period of enhanced risk (Leopold et al., 2014), such as being in the age of onset range for BD onset. At-risk groups are heterogeneous and screening is complicated (Leopold et al., 2014) due to the variety of risk constellations, the episodic course of BD, the multiplicity of subthreshold symptoms, and the symptomatic overlap with other mental disorders in a vulnerable age group (Hauser and Correll, 2013). As several different symptoms might be present prior to BD, a cluster of features, including distal and more enduring symptoms, such as personality traits, and more proximal, recently emerging or worsening clinical symptoms, including depressive and manic/hypomanic symptomatology, might best capture the bipolar prodrome.
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2015, Medical HypothesesCitation Excerpt :This is important because an early detection in BD may slow illness progression, alleviate medical burden and improve long-term functional outcome [100]. Current psychosocial prevention strategies involve targeting ultra-high risk groups such as healthy bipolar offspring (HBO), first degree relatives of BD patients, individuals exposed to early trauma in childhood, and adolescents with substance use disorders (SUDs) [101–103]. However, it is still not possible to identify individuals who will develop bipolar illness based solely on psychopathological traits or early phenomenology [98].
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2015, Journal of Psychiatric ResearchCitation Excerpt :The focus of this study was on clarifying the clinical features that precede the onset of BD, by examining, first, rates of clinical features in the AR group compared to controls, and second, clinical features that predicted later onset of affective disorders in the BD group. First, this study extends previous reports in demonstrating that young subjects at high genetic risk for BD were also at significantly increased risk for developing a broad range of psychopathology (Birmaher et al., 2009; Duffy et al., 2010, 2014; Hillegers et al., 2005; Leopold et al., 2014; Nurnberger et al., 2011; Vandeleur et al., 2012; Wals et al., 2001; Whalley et al., 2011). Specifically, we found that AR subjects were more likely to develop depressive, anxiety and behavioural disorders compared to controls.
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2014, Comprehensive PsychiatryCitation Excerpt :The relative validities of three attenuated psychosis risk screening questionnaires have been explored by determining their accuracy against the SIPS diagnosis as dichotomous predictors using author recommended cut-offs, and all three showed less than acceptable correlation with the SIPS with high false positive rates [13]. Risk symptoms for developing bipolar disorders have not been as well studied as for psychotic disorders, although at-risk criteria have been proposed [54–56]. Early identification has particular relevance in bipolar disorder, as many of those affected are only diagnosed years following the onset of the disorder [57].