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Improving Clinical Prediction of Bipolar Spectrum Disorders in Youth.

Frazier, Thomas W and Youngstrom, Eric A and Fristad, Mary A and Demeter, Christine and Birmaher, Boris and Kowatch, Robert A and Arnold, L Eugene and Axelson, David and Gill, Mary K and Horwitz, Sarah M and Findling, Robert L (2014) Improving Clinical Prediction of Bipolar Spectrum Disorders in Youth. J Clin Med, 3 (1). 218 - 232. ISSN 2077-0383

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This report evaluates whether classification tree algorithms (CTA) may improve the identification of individuals at risk for bipolar spectrum disorders (BPSD). Analyses used the Longitudinal Assessment of Manic Symptoms (LAMS) cohort (629 youth, 148 with BPSD and 481 without BPSD). Parent ratings of mania symptoms, stressful life events, parenting stress, and parental history of mania were included as risk factors. Comparable overall accuracy was observed for CTA (75.4%) relative to logistic regression (77.6%). However, CTA showed increased sensitivity (0.28 vs. 0.18) at the expense of slightly decreased specificity and positive predictive power. The advantage of CTA algorithms for clinical decision making is demonstrated by the combinations of predictors most useful for altering the probability of BPSD. The 24% sample probability of BPSD was substantially decreased in youth with low screening and baseline parent ratings of mania, negative parental history of mania, and low levels of stressful life events (2%). High screening plus high baseline parent-rated mania nearly doubled the BPSD probability (46%). Future work will benefit from examining additional, powerful predictors, such as alternative data sources (e.g., clinician ratings, neurocognitive test data); these may increase the clinical utility of CTA models further.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Frazier, Thomas W
Youngstrom, Eric A
Fristad, Mary A
Demeter, Christine
Birmaher, Borisbirmaher@pitt.eduBIRMAHER
Kowatch, Robert A
Arnold, L Eugene
Axelson, David
Gill, Mary K
Horwitz, Sarah M
Findling, Robert L
Date: 2014
Date Type: Publication
Journal or Publication Title: J Clin Med
Volume: 3
Number: 1
Page Range: 218 - 232
DOI or Unique Handle: 10.3390/jcm3010218
Schools and Programs: School of Medicine > Psychiatry
Refereed: Yes
Uncontrolled Keywords: bipolar disorder, children, classification tree analysis, clinical decision making, risk factors
ISSN: 2077-0383
Funders: NIMH NIH HHS (R01 MH073953), NIMH NIH HHS (R01 MH073816), NIMH NIH HHS (R01 MH073967), NIMH NIH HHS (R01 MH073801), NIMH NIH HHS (P30 MH090322)
Date Deposited: 23 Apr 2015 18:39
Last Modified: 15 Oct 2017 02:55


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