At-risk mental states for bipolar disorder

The strong genetic basis of bipolar spectrum disorders renders the offspring of bipolar parents, known as bipolar offspring, or at-risk individuals, an informative resource for understanding the development of bipolar disorder. In this chapter, we begin with a clinical overview of at-risk psychiatric presentations and discuss the development of a bipolar clinical staging model. Then, we review extant at-risk neuroimaging findings. Next, we provide an overview of pharmacologic and nonpharmacologic treatments in at-risk youth and explore risk factors for manic conversion. Finally, we examine the development of risk calculators to predict manic conversion and their clinical utility to inform individualized treatment and prevention.