[Predicting bipolar disorder: what can we learn from prospective cohort studies?]

Area of Science:

• Psychiatry
• Neuroscience
• Developmental Psychology

Context:

• Bipolar disorder (BD) is a significant global health burden, particularly impacting adolescents and young adults.
• Early diagnosis and intervention are crucial for mitigating the lifelong consequences of BD.
• Understanding the earliest manifestations of BD is key to developing preventative strategies.

Purpose:

• To review prospective cohort studies identifying risk factors for early-onset bipolar disorder (BD).
• To define the characteristics of an "at-risk" syndrome for BD.
• To explore developmental pathways and potential interventions for preventing BD.

Summary:

• Early-onset BD (15-25 years) often follows a prodrome starting before age 14, initially with non-specific symptoms overlapping with psychosis or depression.
• An "at-risk" syndrome for BD includes mood lability, depression, anxiety, sleep/conduct issues, attention deficits, altered energy, and family history.
• The progression of BD involves a gradual shift from non-specific to specific symptoms, highlighting the need for early identification and intervention.

Impact:

• Identifying individuals with an "at-risk" BD syndrome can facilitate early, potentially benign interventions.
• A clinical staging model for BD may allow for targeted treatments, reserving more potent therapies for severe or resistant cases.
• Further research into developmental pathways can refine diagnostic and preventative approaches for BD.