A positive family history for bipolar disorder (BD) is presently the strongest predictor for BD. Over the last 2 decades, several longitudinal studies among children of patients with BD (bipolar offspring) identified converging evidence for early BD manifestations and associated parental and environmental risk factors.¹ Risk for BD is elevated in bipolar offspring, but affected families want to know an individual risk estimate. Moreover, clinicians and policy makers want to know how to identify those youth at ultra high risk because this information may affect treatment and monitoring strategies. In this issue of JAMA Psychiatry, Hafeman and colleagues² present a risk calculator for bipolar spectrum disorder (BPSD) in youth at familial risk for BD. Their work is an important step forward in the BD research field and potentially for clinical practice. Risk calculators are novel in psychiatry³ but are well-known instruments in general medicine (eg, the Framingham Risk Score is a widely used tool to assess risk for cardiovascular diseases). By entering specific risk variables, risk calculators may guide clinicians to weigh individual risk for disease and aid clinical decision making (eg, starting early intervention and frequent monitoring). The study by Hafeman and colleagues² is the first to date to investigate the use of a risk calculator in youth at familial risk for BD.

目前，双相情感障碍（BD）的家族史阳性是BD的最强预测因子。在过去的20年中，对BD（双相后代）患儿的几项纵向研究确定了早期BD表现以及相关的父母和环境危险因素的越来越多的证据。¹双相子孙后代患BD的风险增加，但受影响的家庭希望了解个人的风险估计。此外，临床医生和政策制定者想知道如何识别那些处于极高风险中的年轻人，因为这些信息可能会影响治疗和监测策略。在本期《JAMA精神病学》中，Hafeman及其同事²提出了患有家族性BD风险的年轻人的双相谱障碍（BPSD）风险计算器。他们的工作是BD研究领域迈出的重要一步，并可能对临床实践具有重要意义。风险计算器在精神病学^3中是新颖的，但在普通医学中是众所周知的工具（例如，弗雷明汉风险评分是一种广泛使用的评估心血管疾病风险的工具）。通过输入特定的风险变量，风险计算器可以指导临床医生衡量疾病的个体风险并帮助临床决策（例如，开始早期干预和频繁监测）。Hafeman及其同事²的研究是迄今为止首次调查在患有BD家族风险的年轻人中使用风险计算器的情况。