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Predicting the emergence of full-threshold bipolar I, bipolar II and psychotic disorders in young people presenting to early intervention mental health services

Published online by Cambridge University Press:  30 October 2020

Joanne S. Carpenter Open the ORCID record for Joanne S. Carpenter [Opens in a new window] ,
Jan Scott ,
Frank Iorfino Open the ORCID record for Frank Iorfino [Opens in a new window] ,
Jacob J. Crouse ,
Nicholas Ho ,
Daniel F. Hermens ,
Shane P. M. Cross ,
Sharon L. Naismith ,
Adam J. Guastella  and
Elizabeth M. Scott
...Show all authors
Joanne S. Carpenter*
Affiliation:
Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
Jan Scott
Affiliation:
Department of Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, England Diderot University, Sorbonne City, Paris, France
Frank Iorfino
Affiliation:
Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
Jacob J. Crouse
Affiliation:
Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
Nicholas Ho
Affiliation:
Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
Daniel F. Hermens
Affiliation:
Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
Shane P. M. Cross
Affiliation:
Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
Sharon L. Naismith
Affiliation:
Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
Adam J. Guastella
Affiliation:
Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
Elizabeth M. Scott
Affiliation:
Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia School of Medicine, University of Notre Dame, Sydney, Australia
Ian B. Hickie
Affiliation:
Youth Mental Health Team, Brain & Mind Centre, The University of Sydney, Camperdown, Australia
*
Author for correspondence: Joanne S. Carpenter, E-mail: joanne.carpenter@sydney.edu.au
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Abstract

Background

Predictors of new-onset bipolar disorder (BD) or psychotic disorder (PD) have been proposed on the basis of retrospective or prospective studies of ‘at-risk’ cohorts. Few studies have compared concurrently or longitudinally factors associated with the onset of BD or PDs in youth presenting to early intervention services. We aimed to identify clinical predictors of the onset of full-threshold (FT) BD or PD in this population.

Method

Multi-state Markov modelling was used to assess the relationships between baseline characteristics and the likelihood of the onset of FT BD or PD in youth (aged 12–30) presenting to mental health services.

Results

Of 2330 individuals assessed longitudinally, 4.3% (n = 100) met criteria for new-onset FT BD and 2.2% (n = 51) met criteria for a new-onset FT PD. The emergence of FT BD was associated with older age, lower social and occupational functioning, mania-like experiences (MLE), suicide attempts, reduced incidence of physical illness, childhood-onset depression, and childhood-onset anxiety. The emergence of a PD was associated with older age, male sex, psychosis-like experiences (PLE), suicide attempts, stimulant use, and childhood-onset depression.

Conclusions

Identifying risk factors for the onset of either BD or PDs in young people presenting to early intervention services is assisted not only by the increased focus on MLE and PLE, but also by recognising the predictive significance of poorer social function, childhood-onset anxiety and mood disorders, and suicide attempts prior to the time of entry to services. Secondary prevention may be enhanced by greater attention to those risk factors that are modifiable or shared by both illness trajectories.

Keywords

Bipolarmental healthpsychosisrisk predictionyouth
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 10 , July 2022 , pp. 1990 - 2000
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Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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