Affective lability as a prospective predictor of subsequent bipolar disorder diagnosis: a systematic review

Taylor, Rosie H.; Ulrichsen, Andrea; Young, Allan H.; Strawbridge, Rebecca

doi:10.1186/s40345-021-00237-1

Table 2 Study characteristics and findings at follow-up

From: Affective lability as a prospective predictor of subsequent bipolar disorder diagnosis: a systematic review

Article	FU n	% lost at FU	FU duration (years)	Diagnostic Tool	Diagnostic assessor	Diagnosed with BD n (%)	Rates of BD type	Affective lability/BD association
Akiskal et al. 1995	559	NR	11	SADS (DSM /RDC)	Clinician	70 (13)	22 BD-I, 48 BD-II	BD-II X² = 19.92 + + + (specificity = 86%, sensitivity = 42%)
Angst et al. 2003	591	NR	15	DSM-IV criteria	Clinician	86 (15)	41 BD-II, 45 BSD	BD-II + + BSD OR = 3.4, 95% CI [1.7, 6.6] + +
DeGeorge et al. 2014*	112	23%	3.1 (SD = 0.5, range 1.7—4.8)	SCID	Advanced grad (81%), psychologist + undergrad (19%)	13 (14)	BSD and BD BSD	BSD OR = 2.99 + BD OR = .532, CI [.08–3.45]
Sperry et al. 2020*	108	22%	3.1 (SD = 0.5, range 1.7—4.8)	SCID	Advanced grad (81%), psychologist + undergrad (19%)	4 (4)	BSD and BD BSD	PA: OR = 1.91, 95% CI [1.14, 3.18] + NA: OR = 1.54, 95% CI [1.00, 2.38] +
Egeland et al. 2012	221	NR	16	Adapted K-SADS, clinical records	Clinician	9 (4)	All BD-I	Mood lability more present in BD at risk sample than controls (p = 0.063)
Gan et al. 2011	268	22%	1	SCID-I	Psychiatrist	27 (24)	2 BD-I, 25 BD-II	OR = 0.487 +
Hafeman et al. 2017	412	14%	Mean = 8.34	K-SADS (DSM-IV)	Trained interviewers + psychiatrist review	44/299 at-risk (15)	15 BD-I/II, 29 BSD	X² = 4.00 +
Kochman et al. 2005	80	27%	2–4 (27 months, SD = 9 months)	K-SADS	Investigator	35 (43)	All BSD	Prior instability in 64% of BSD; BSD vs non-BSD difference + + +
Ratheesh et al. 2015	52	26%	1	LIFE	Unspecified	4 (8)	3 BD-II, 1 BD-NOS	SES = 0.27 (p = 0.13), 95% CI [0.00,0.59]
Salvatore et al. 2013	107	79%	Mean = 4	SCID	Blinded investigator	20 (19)	10 BD-I, 10 BD-NOS	RR = 1.45 +
Tohen et al. 2012	49	13%	4	SCID	Blinded experienced raters	14 (33)	BD-I or BD-NOS	X² = 4.85 +

FU follow-up, n number of, BD bipolar disorder, BPSD bipolar spectrum disorder, DSM Diagnostic and Statistical Manual of Mental Disorders, NR not reported, SADS The Schedule for Affective Disorders and Schizophrenia, RDC the Research Diagnostic Criteria, BPI Bipolar Disorder Type 1, BPII bipolar disorder type 2, DSM-IV the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, BSD bipolar spectrum disorders, OR Odds ratio, CI Confidence intervals, SD standard deviation, SCID Structured Clinical Interviews for DSM, PA positive affect, NA negative affect, K-SADS Kiddie Schedule for Affective Disorders and Schizophrenia, SCID-I Structured Clinical Interview for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders for Axis I Disorders, LIFE The Longitudinal Interval Follow-up Evaluation for DSM IV, BD-NOS Bipolar disorder not otherwise specified, SES standardised effect size. RR Risk Ratio
^*Sperry et al. 2020 and DeGeorge et al. 2014 are two papers from the same study. In both papers ‘% lost at FU’ and ‘FU duration’ are reported for the participant pool including some participants with initial BD diagnoses (we report averages from the total sample, which are expected to be comparable)
+ p < 0.05, + + p < 0.01, + + + p < 0.001

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