Prospective progression from high-prevalence disorders to bipolar disorder: Exploring characteristics of pre-illness stages

- Alcohol use disorders and a family history of substance use disorders may predict onset of BD among youth with depression, anxiety and substance use disorders.
- Subthreshold manic subgroup of Bipolar-At-Risk (BAR) criteria also predicts conversion to BD.
- Severity of depression and cannabis use as risk factors of conversion may merit further study.

BackgroundIdentification of risk factors within precursor syndromes, such as depression, anxiety or substance use disorders (SUD), might help to pinpoint high-risk stages where preventive interventions for Bipolar Disorder (BD) could be evaluated.MethodsWe examined baseline demographic, clinical, quality of life, and temperament measures along with risk clusters among 52 young people seeking help for depression, anxiety or SUDs without psychosis or BD. The risk clusters included Bipolar At-Risk (BAR) and the Bipolarity Index as measures of bipolarity and the Ultra-High Risk assessment for psychosis. The participants were followed up for 12 months to identify conversion to BD. Those who converted and did not convert to BD were compared using Chi-Square and Mann Whitney U tests.ResultsThe sample was predominantly female (85%) and a majority had prior treatment (64%). Four participants converted to BD over the 1-year follow up period. Having an alcohol use disorder at baseline (75% vs 8%, χ2=14.1, p<0.001) or a family history of SUD (67% vs 12.5%, χ2=6.0, p=0.01) were associated with development of BD. The sub-threshold mania subgroup of BAR criteria was also associated with 12-month BD outcomes. The severity of depressive symptoms and cannabis use had high effects sizes of association with BD outcomes, without statistical significance.Conclusions and limitationsThe small number of conversions limited the power of the study to identify associations with risk factors that have previously been reported to predict BD. However, subthreshold affective symptoms and SUDs might predict the onset of BD among help-seeking young people with high-prevalence disorders.