Brief report A preliminary evaluation of the validity of at-risk criteria for bipolar disorders in help-seeking adolescents and young adults Andreas Bechdolf ⁎ ,1,2 , Barnaby Nelson, Sue M. Cotton, Andrew Chanen, Andrew Thompson, Jonathan Kettle, Phillippe Conus, G. Paul Amminger, Alison R. Yung, Michael Berk, Patrick D. McGorry ORYGEN Youth Health, Department of Youth Mental Health, University of Melbourne, Australia article info abstract Article history: Received 11 December 2009 Received in revised form 8 June 2010 Accepted 9 June 2010 Available online xxxx Introduction: We have developed ultra-high risk criteria for bipolar affective disorder (bipolar at-risk — BAR) which include general criteria such as being in the peak age range of the onset of the disorder and a combination of specific criteria including sub-threshold mania, depressive symptoms, cyclothymic features and genetic risk. In the current study, the predictive validity of these criteria were tested in help-seeking adolescents and young adults. Method: This medical file-audit study was conducted at ORYGEN Youth Health (OYH), a public mental health program for young people aged between 15 and 24 years and living in metropolitan Melbourne, Australia. BAR criteria were applied to the intake assessments of all non-psychotic patients who were being treated in OYH on 31 January, 2008. All entries were then checked for conversion criteria. Hypomania/mania related additions or alterations to existing treatments or initiation of new treatment by the treating psychiatrist served as conversion criteria to mania. Results: The BAR criteria were applied to 173 intake assessments. Of these, 22 patients (12.7%) met BAR criteria. The follow-up period of the sample was 265.5 days on average (SD 214.7). There were significantly more cases in the BAR group (22.7%, n = 5) than in the non-BAR group (0.7%, n = 1) who met conversion criteria (p b .001). Conclusions: These findings support the notion that people who develop a first episode of mania can be identified during the prodromal phase. The proposed criteria need further evaluation in prospective clinical trials. © 2010 Elsevier B.V. All rights reserved. Keywords: Prodrome Mania Bipolar disorder 1. Introduction Clinicians and researchers have recently suggested that intervening early in the course of bipolar affective disorder (BPAD), in the prodromal phase, may reduce this personal and economic burden, as this strategy has the potential to delay, lessen the severity of, or even prevent full-blown disorder (Berk et al., 2007; Conus et al., in press; Correll et al., 2007; McGorry et al., 2006; Salvadore et al., 2008). Based on analogous considerations in psychotic disorders (McGorry et al., 2003), Yung and colleagues (Yung et al., 1998) developed an ultra-high risk (UHR) approach for psychosis. The aim of this approach was to identify help-seeking, troubled young people who have manifest symptoms and impaired functioning and demonstrate a substantially increased risk of psychosis onset, in whom indicated prevention efforts might be justified. The psychosis at-risk criteria combined sub-threshold symptoms, decrease in functioning and genetic risk in young help seekers at the peak age range of the onset of the disorder [see (Yung et al., 1998) for the full criteria]. Prospective follow- up studies indicated that 20–40% of help-seeking young people Journal of Affective Disorders xxx (2010) xxx–xxx ⁎ Corresponding author. ORYGEN Youth Health (Locked Bag 10), 35 Poplar Road, 3052 Parkville, Victoria, Australia. Tel.: +61 3 93422823; fax: +61 3 93423106. E-mail address: andreas.bechdolf@uk-koeln.de (A. Bechdolf). 1 Department of Psychiatry, University of Melbourne, Australia. 2 Department of Psychiatry and Psychotherapy, University of Cologne, Germany. JAD-04635; No of Pages 5 0165-0327/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.jad.2010.06.016 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad Please cite this article as: Bechdolf, A., et al., A preliminary evaluation of the validity of at-risk criteria for bipolar disorders in help-seeking adolescents and young adults, J. Affect. Disord. (2010), doi:10.1016/j.jad.2010.06.016