How does a Developmental Perspective inform us about the early Natural History of Bipolar Disorder?
Bibliographic record
Abstract
OBJECTIVE: The focus of this paper is to explore how a developmental perspective can advance understanding of the clinical trajectory into bipolar disorder (BD) and clarify controversies regarding the diagnosis in youth. METHOD: In this selective review, we focus on findings from longitudinal studies of general population and high-risk pediatric cohorts in order to inform our understanding of the development of BD in youth. Also highlighted are related aspects of the debate about the diagnosis in young children and a discussion of the implications of the findings for advancing early detection and intervention clinical and research efforts. RESULTS: Evidence overwhelmingly suggests that BD typically onsets in adolescence and early adulthood, with the depressive polarity of the illness dominating the early course. Non-specific childhood antecedents have been noted in some high-risk individuals. However, in youth without a confirmed familial risk of BD, manic-like symptoms have little prognostic significance for BD and not uncommonly form part of the normative adolescent experience. Over-emphasis of symptoms and reliance on parent report alone, alongside the relative neglect of the child's developmental stage and risk profile, contributes to the over diagnosis in young children and under recognition of BD early in the clinical course. CONCLUSIONS: Longitudinal population and high-risk studies over development have made major contributions to our understanding of the early natural history of BD in youth. Implications call for a different diagnostic approach to facilitate accurate identification of youth in the early clinical stages of psychiatric disorders and to differentiate between the emerging illness trajectories and transient normative symptoms in childhood and adolescence.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.003 |
| Scholarly communication | 0.002 | 0.006 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".