Objective

With each recurrence the prognosis of bipolar disorder (BD) worsens, indicating the need to identify the factors associated with increased recurrence risk. The course of BD is heterogenous and although risk factors for recurrence for the group as a whole have been reported in the literature, identification of risk factors for a specific individual are crucial for developing personalized treatments.

Method

A total of 363 recovered BD youths/young adults from the Course and Outcome of Bipolar Youth (COBY) study were included. Participants were evaluated on average every 7 months for a median of 12.5 years and interviewed with standard instruments. Risk factors of recurrence from the literature were used to build a risk calculator (RC) to predict recurrence risk at different time intervals.

Results

Approximately 80% of participants had at least one syndromal recurrence and 60% had ≥2 recurrences, particularly depressions. The 6-month and 1-, 2-, 3-, and 5-year RC showed an accuracy between 72% and 82% for predicting any mood recurrences, and up to 80% for depression and 89% for hypo/mania (sensitivity/specificity both 0.74). The most influential recurrence risk factors were shorter recovery lengths, younger age at assessment, earlier mood onset, and more severe prior depression. Although important, other factors associated with recurrence risk, such as interepisodic subsyndromal mood symptoms and comorbidities, did not influence the RC score beyond factors noted above.

Conclusion

The RC provides a useful tool for predicting an individual’s recurrence risk of depression and/or hypo/mania in BD youths and for developing personalized interventions and informing research. Replication studies are warranted.

中文翻译：

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预测患有双相情感障碍的青少年和年轻人的情绪复发的个性化风险。

客观的

随着每次复发，双相情感障碍 (BD) 的预后都会恶化，这表明需要确定与复发风险增加相关的因素。BD 的病程是异质的，尽管文献报道了整个群体复发的风险因素，但确定特定个体的风险因素对于开发个性化治疗至关重要。

方法

共包括 363 名从双相青年的课程和结果 (COBY) 研究中恢复的 BD 青年/年轻人。参与者平均每 7 个月接受一次评估，中位数为 12.5 年，并使用标准仪器进行访谈。文献中复发的风险因素用于构建风险计算器 (RC) 以预测不同时间间隔的复发风险。

结果

大约 80% 的参与者至少有 1 次综合征复发，60% 有≥2 次复发，尤其是抑郁症。6 个月和 1 年、2 年、3 年和 5 年的 RC 显示预测任何情绪复发的准确度在 72% 和 82% 之间，抑郁症的准确率高达 80%，低/躁狂症的准确率高达 89%（敏感性/特异性均为 0.74）。最有影响的复发风险因素是更短的恢复时间、更年轻的评估年龄、更早的情绪发作和更严重的既往抑郁症。尽管很重要，但与复发风险相关的其他因素，例如发作间期亚综合征情绪症状和合并症，除上述因素外，并未影响 RC 评分。

结论

RC 提供了一种有用的工具，可用于预测个体在 BD 青少年中患抑郁症和/或轻躁狂/躁狂症的复发风险，以及制定个性化干预措施和为研究提供信息。有必要进行复制研究。