{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T04:26:57Z","timestamp":1760243217701,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2014,3,10]],"date-time":"2014-03-10T00:00:00Z","timestamp":1394409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm3010218","type":"journal-article","created":{"date-parts":[[2014,3,10]],"date-time":"2014-03-10T07:29:49Z","timestamp":1394436589000},"page":"218-232","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Improving Clinical Prediction of Bipolar Spectrum Disorders  in Youth"],"prefix":"10.3390","volume":"3","author":[{"given":"Thomas","family":"Frazier","sequence":"first","affiliation":[{"name":"Center for Autism, Cleveland Clinic, Cleveland, OH 44104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Youngstrom","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Fristad","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Demeter","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Division of Child and Adolescent Psychiatry, University Hospitals Case Medical Center, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boris","family":"Birmaher","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA 15213, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Kowatch","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Nationwide Children's Hospital, Columbus, OH 4320, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L.","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Division of Child and Adolescent Psychiatry, Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Axelson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA 15213, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA 15213, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Horwitz","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, New York University School of Medicine,  New York, NY 10016, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Findling","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Johns Hopkins University, Baltimore, MD 21287, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2014,3,10]]},"reference":[{"key":"ref_1","unstructured":"Kraemer, H.C. (1992). Evaluating Medical Tests: Objective and Quantitative Guidelines, Sage Publications."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1111\/j.1399-5618.2012.01034.x","article-title":"What differentiates children visiting outpatient mental health services with bipolar spectrum disorder from children with other psychiatric diagnoses?","volume":"14","author":"Fristad","year":"2012","journal-title":"Bipolar Disord."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Meehl, P.E. (1954). Clinical versus Statistical Prediction: A Theoretical Analysis and a Review of the Evidence, University of Minnesota Press.","DOI":"10.1037\/11281-000"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1126\/science.2648573","article-title":"Clinical versus actuarial judgment","volume":"243","author":"Dawes","year":"1989","journal-title":"Science"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Garb, H.N. (1998). Studying the Clinician: Judgment Research and Psychological Assessment, American Psychological Association.","DOI":"10.1037\/10299-000"},{"key":"ref_6","unstructured":"Meehl, P.E. (1973). Psychodiagnosis: Selected Papers, University of Minnesota Press."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1037\/h0048070","article-title":"Antecedent probability and the efficiency of psychometric signs, patterns, or cutting scores","volume":"52","author":"Meehl","year":"1955","journal-title":"Psychol. Bull."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., and Lemeshow, S. (2000). Applied Logistic Regression, Wiley. [2nd ed.].","DOI":"10.1002\/0471722146"},{"key":"ref_9","unstructured":"Yarnold, P.R., and Soltysik, R.C. (2005). Optimal Data Analysis: A Guidebook with Software for Windows, American Psychological Association."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1023\/B:LAHU.0000029138.92866.af","article-title":"Identifying three types of violent offenders and predicting violent recidivism while on probation: A classification tree analysis","volume":"28","author":"Stalans","year":"2004","journal-title":"Law Hum. Behav."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1097\/00005650-199805000-00013","article-title":"A classification tree analysis of selection for discretionary treatment","volume":"36","author":"Feinglass","year":"1998","journal-title":"Med. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.4088\/JCP.09m05835yel","article-title":"Longitudinal assessment of manic symptoms (LAMS) study: Background, design, and initial screening results","volume":"71","author":"Horwitz","year":"2010","journal-title":"J. Clin. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"831","DOI":"10.4088\/JCP.v69n0517","article-title":"Developing a 10-item mania scale from the parent general behavior inventory for children and adolescents","volume":"69","author":"Youngstrom","year":"2008","journal-title":"J. Clin. Psychiatry"},{"key":"ref_14","first-page":"58","article-title":"A survey of stress and support for parents of children with early-onset bipolar disorder","volume":"3","author":"Sisson","year":"2001","journal-title":"Bipolar Disord."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/S0165-1781(03)00134-3","article-title":"The stressful life events schedule for children and adolescents: Development and validation","volume":"119","author":"Williamson","year":"2003","journal-title":"Psychiatry Res."},{"key":"ref_16","unstructured":"American Psychiatric Association (2001). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [4th ed.]."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1001\/archpsyc.63.2.175","article-title":"Clinical course of children and adolescents with bipolar spectrum disorders","volume":"63","author":"Birmaher","year":"2006","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1097\/00004583-199707000-00021","article-title":"Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): Initial reliability and validity data","volume":"36","author":"Kaufman","year":"1997","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/S0165-0327(98)00176-1","article-title":"Prepubertal and young adolescent bipolarity versus ADHD: Assessment and validity using the WASH-U-KSADS, CBCL and TRF","volume":"51","author":"Geller","year":"1998","journal-title":"J. Affect. Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1097\/00004583-200104000-00014","article-title":"Reliability of the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS) mania and rapid cycling sections","volume":"40","author":"Geller","year":"2001","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1001\/archpsyc.63.10.1139","article-title":"Phenomenology of children and adolescents with bipolar spectrum disorders","volume":"63","author":"Axelson","year":"2006","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1097\/01.nmd.0000230392.83607.c5","article-title":"Rating scales, scales of measurement, issues of reliability: Resolving some critical issues for clinicians and researchers","volume":"194","author":"Cicchetti","year":"2006","journal-title":"J. Nervous Mental Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1001\/archpsyc.57.7.675","article-title":"Brief screening for family psychiatric history: The family history screen","volume":"57","author":"Weissman","year":"2000","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1002\/ajmg.b.30764","article-title":"The validity of the family history screen for assessing family history of mental disorders","volume":"150","author":"Milne","year":"2009","journal-title":"Am. J. Med. Genet."},{"key":"ref_25","unstructured":"Geller, B., and DelBello, M.P. (2003). Bipolar Disorder in Childhood and Early Adolescence, Guilford Press."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1192\/bjp.176.4.312","article-title":"Developing a clinically useful actuarial tool for assessing violence risk","volume":"176","author":"Monahan","year":"2000","journal-title":"Br. J. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1177\/009385402236732","article-title":"A multiple models approach to assessing recidivism risk: Implications for judicial decision making","volume":"29","author":"Silver","year":"2002","journal-title":"Crim. Justice Behav."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1177\/0093854800027006004","article-title":"Constructing actuarial devices for predicting recidivism: A comparison of methods","volume":"27","author":"Silver","year":"2000","journal-title":"Crim. Justice Behav."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1023\/A:1005478820425","article-title":"A classification tree approach to the development of actuarial violence risk assessment tools","volume":"24","author":"Steadman","year":"2000","journal-title":"Law Hum. Behav."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1037\/a0016973","article-title":"An introduction to recursive partitioning: Rationale, application, and characteristics of classification and regression trees, bagging, and random forests","volume":"14","author":"Strobl","year":"2009","journal-title":"Psychol. Methods"},{"key":"ref_31","unstructured":"Straus, S.E., Richardson, W.S., Glasziou, P., and Haynes, R.B. (2005). Evidence-Based Medicine: How to Practice and Teach EBM, Churchill Livingstone. [3rd ed.]."},{"key":"ref_32","unstructured":"Guyatt, G.H., and Rennie, D. (2002). Users\u2019 Guides to the Medical Literature, AMA Press."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.chc.2008.12.002","article-title":"The assessment of children and adolescents with bipolar disorder","volume":"18","author":"Youngstrom","year":"2009","journal-title":"Child Adolesc. Psychiatr. Clin. N. Am."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1080\/15374416.2012.736358","article-title":"Future directions in psychological assessment: Combining evidence-based medicine innovations with psychology\u2019s historical strengths to enhance utility","volume":"42","author":"Youngstrom","year":"2013","journal-title":"J. Clin. Child Adolesc. Psychol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1037\/a0025775","article-title":"Generalizability of evidence-based assessment recommendations for pediatric bipolar disorder","volume":"24","author":"Jenkins","year":"2012","journal-title":"Psychol. Assess"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1002\/mpr.289","article-title":"Meta-analyses of agreement between diagnoses made from clinical evaluations and standardized diagnostic interviews","volume":"18","author":"Rettew","year":"2009","journal-title":"Int. J. Methods Psychiatr. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.beth.2008.07.002","article-title":"Acceptance of structured diagnostic interviews for mental disorders in clinical practice and research settings","volume":"40","author":"Suppiger","year":"2009","journal-title":"Behav. Ther."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.chc.2008.11.009","article-title":"Psychosocial treatments for childhood and adolescent bipolar disorder","volume":"18","author":"West","year":"2009","journal-title":"Child Adolesc. Psychiatr. Clin. N. Am."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1001\/archpsyc.65.9.1053","article-title":"Family-focused treatment for adolescents with bipolar disorder: Results of a 2-year randomized trial","volume":"65","author":"Miklowitz","year":"2008","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1001\/archgenpsychiatry.2009.112","article-title":"Impact of multifamily psychoeducational psychotherapy in treating children aged 8 to 12 years with mood disorders","volume":"66","author":"Fristad","year":"2009","journal-title":"Arch. Gen. Psychiatry"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/3\/1\/218\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T21:09:02Z","timestamp":1760216942000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/3\/1\/218"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,3,10]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2014,3]]}},"alternative-id":["jcm3010218"],"URL":"https:\/\/doi.org\/10.3390\/jcm3010218","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2014,3,10]]}}}