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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Researchers Develop Calculator to Predict Risk of Bipolar Disorder in Youth

Youth with subthreshold manic symptoms are at greater risk of developing bipolar disorder. Researchers have developed a risk calculator that can predict which of these at-risk youth are most likely to convert to bipolar disorder within five years. In a study published in the Journal of the American Academy of Child & Adolescent Psychiatry, the researchers showed this bipolar risk calculator could identify bipolar conversion with about 71% accuracy.

“The quantification of an individual’s risk could inform treatment decisions, such as the use and specific choice of antidepressant medications for a depressed BP-NOS [bipolar disorder–not otherwise specified] youth at high risk for conversion vs. a depressed BP-NOS youth at low risk for conversion,” wrote Boris Birmaher, M.D., of the University of Pittsburgh School of Medicine and colleagues. “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.”

Birmaher and colleagues selected predictor variables for the risk calculator based on the results of a recent meta-analysis that identified common prodromal symptoms in individuals who later developed bipolar disorder. The final calculator included mood-related scores on the K-SADS Kiddie Mania Rating Scale and Kiddie Depression Rating Scale, as well as scores on the Screen for Child Anxiety Related Emotional Disorders, Behavior Control Scale, and Children’s Global Assessment Scale. Family history of mania, duration of subthreshold symptoms, and demographic factors including age, sex, and race were also incorporated.

The researchers tested this calculator on 140 youth aged 6 to 17 who were part of a long-term bipolar disorder study. All the youth had subthreshold bipolar symptoms (known as bipolar disorder–not otherwise specified [BP-NOS] in DSM-IV). These youth were assessed every seven months for about 11.5 years; 75 of the youth converted to either bipolar I or bipolar II disorder, 57 of whom converted within five years. The risk calculator could discriminate those youth who did or did not convert with around 71% accuracy overall (74% accuracy for bipolar I and 70% for bipolar II). This prediction rate is comparable to the performance of recently developed risk calculators for psychosis.

The researchers then validated the calculator in a second, independent cohort of 58 BP-NOS youth, and the calculator predicted five-year bipolar conversion with 75% accuracy, suggesting the calculator is generalizable to other samples of patients.

“If replicated, the risk calculator provided in this study offers a useful tool for clinicians to predict an individual’s child’s risk of converting from subsyndromal mania to BP-I/II, and thus inform personalized treatment decisions,” the authors wrote. 

To read more about risk calculators, see the Psychiatric News article “Multimodal Approach May Improve Ability to Predict Transition to Psychosis.”

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