Advancing the prediction of factors associated with bipolar disorder risk: utilizing early recognition tools and polygenic risk scores

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Silvia Biere - , University Hospital Frankfurt (Author)
  • Silke Matura - , University Hospital Frankfurt (Author)
  • Kristiyana Petrova - , University Hospital Frankfurt (Author)
  • Fabian Streit - , Heidelberg University , German Center for Mental Health (DZPG) Partner Site Mannheim-Heidelberg-Ulm (Author)
  • Andreas G. Chiocchetti - , University Hospital Frankfurt (Author)
  • Kira F. Ahrens - , University Hospital Frankfurt (Author)
  • Charlotte Schenk - , University Hospital Frankfurt (Author)
  • Michael M. Plichta - , University Hospital Frankfurt (Author)
  • Raffael Kalisch - , Technische Universität Darmstadt, University Medical Center Mainz (Author)
  • Michèle Wessa - , Heidelberg University , German Cancer Research Center (DKFZ) (Author)
  • Viola Oertel - , University Hospital Frankfurt (Author)
  • Andrea Pfennig - , Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden (Author)
  • Michael Bauer - , Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden (Author)
  • Philipp Ritter - , Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus Dresden (Author)
  • Thomas G. Schulze - , Ludwig Maximilian University of Munich (Author)
  • Christoph U. Correll - , Charité – Universitätsmedizin Berlin, Zucker Hillside Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (Author)
  • Andreas Bechdolf - , Vivantes Humboldt-Clinic, Charité – Universitätsmedizin Berlin (Author)
  • Klaus Lieb - , University Medical Center Mainz (Author)
  • Oliver Tüscher - , University Medical Center Mainz , Leibniz Institute of Resilience (LIR), Institute of Molecular Biology (IMB) gGmbH (Author)
  • Sarah Kittel-Schneider - , University Hospital Frankfurt, University College Cork, University of Würzburg (Author)
  • Andreas Reif - , University Hospital Frankfurt, Fraunhofer Institute for Translational Medicine and Pharmacology (Author)
  • Thorsten M. Kranz - , University Hospital Frankfurt (Author)

Abstract

Bipolar disorder (BD) is a highly heritable mental illness that affects ∼ 1–2% of the world’s population and has complex genetic and environmental underpinnings. Early detection is critical to improving treatment outcomes, but current strategies have limited predictive power. Early detection tools such as the Early Phase Inventory for Bipolar Disorder (EPIbipolar) and the Bipolar At-Risk (BARS) criteria assess phenotypic risk factors, including family history (FH) and subthreshold mood problems. Polygenic risk scores (PRS) are a quantitative metric of genetic susceptibility. This study examined the associations between BD-PRS and screening tools in order to assess their combined potential to identify individuals at risk of BD with improved predictive accuracy. The analysis included 1068 participants, including 199 at-risk young adults aged 15 to 35 years and 869 healthy controls aged 18 to 50 years. All of them had no prior psychiatric disorders. Inclusion criteria for the at-risk group comprised a positive FH (1st or 2nd degree) for BD, major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD), or the presence of specific BD risk factors (e.g., subthreshold hypomanic symptoms, mood swings, or sleep disturbances). Participants who had a confirmed BD, schizophrenia, schizoaffective disorder diagnosis, or other psychiatric conditions that could explain the symptomatology, were excluded. Diagnostic assessments that were utilized validated early detection instruments, including EPIbipolar, Bipolar Prodrome Interview and Symptom Scale-Prospective (BPSS-FP), and BARS criteria. Binary logistic regression models were employed to assess associations between BD-PRS and phenotypic risk markers, with adjustments for population stratification. Results revealed significant associations between BD-PRS and BARS criteria risk groups and EPIbipolar “at risk” criteria compared to controls. Significant associations were also identified for subscales including FH for BD, MDD, or schizophrenia, sleep and circadian rhythm disturbances, depressive characteristics, functional impairment, and episodic course. However, no significant associations were observed between BD-PRS and BPSS-FP, which highlights variability in the sensitivity of different early detection instruments. Our findings emphasize the potential of combining genetic susceptibility measures with phenotypic risk markers to enhance early detection strategies for BD. Further research is needed to optimize predictive models and evaluate the clinical utility of PRS in early intervention frameworks.

Details

Original languageEnglish
Article number2
JournalInternational journal of bipolar disorders
Volume14
Issue number1
Publication statusPublished - 10 Dec 2025
Peer-reviewedYes

External IDs

ORCID /0000-0002-3415-5583/work/203813740
ORCID /0000-0002-2666-859X/work/203814159
PubMed 41369840

Keywords

Sustainable Development Goals

Keywords

  • Bipolar disorder, Early recognition, Early symptoms, Family history, Polygenic risk score, Risk factors