Patients at risk for bipolar disorder would benefit from long-term monitoring and support

Key takeaways:

• Patients who met bipolar at-risk criteria were at significantly higher risk for bipolar disorder over the next decade.
• Opportunities for intervention could extend into the third and fourth decades of life.

Factors previously associated with short-term risk for new-onset bipolar disorder also were associated with significantly higher risk after more than 10 years of follow-up, according to a study published in JAMA Network Open.

Led by researchers out of Australia, the study tracked the long-term association between bipolar at-risk (BAR) criteria — which includes subthreshold mania, cyclothymic features, subthreshold depression and family history of bipolar disorder (BD) — and the development of BD.

Participants (n = 69) were originally recruited at ages 15 to 25 years into a previous study in a tertiary youth mental health care setting in Melbourne, Australia.

In this study, researchers followed-up with 60 of those patients — 28 who met BAR criteria at baseline and a matched group of 32 non-BAR patients. The mean age of the cohort was 32.9 years and 81.7% were women.

Over a mean follow-up period of 11.1 years, 28.6% of the BAR group (n = 8) developed BD, while none did in the comparison group. The risk for BD was significantly higher in the group that met BAR criteria (P < .001).

Researchers also reported that transitions to BD occurred throughout the follow-up period, suggesting that “the window for providing enhanced support, monitoring or preventive interventions may extend into the third and fourth decades of life.”

The results suggest that longer-term monitoring and support could benefit patients who meet BAR criteria, researchers concluded, adding that future longer-term studies evaluating predictive properties will aid the clinical implementation of BAR criteria.

Researchers highlighted “an urgent need for assessment of long-term predictive properties and case-finding accuracy, which could pave the way for preventive intervention trials.”

The study’s limitations included a possible underestimate of BD onset due to incomplete data. Also, 44 participants (62.8%) did not have a structured diagnostic assessment.