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Although (hypo)manic symptoms are common in adolescence, transition to
adult bipolar disorder is infrequent.
To examine whether the risk of transition to bipolar disorder is
conditional on the extent of persistence of subthreshold affective
In a 10-year prospective community cohort study of 3021 adolescents and
young adults, the association between persistence of affective symptoms
over 3 years and the 10-year clinical outcomes of incident DSM–IV
(hypo)manic episodes and incident use of mental healthcare was
Transition to clinical outcome was associated with persistence of
symptoms in a dose-dependent manner. Around 30–40% of clinical outcomes
could be traced to prior persistence of affective symptoms.
In a substantial proportion of individuals, onset of clinical bipolar
disorder may be seen as the poor outcome of a developmentally common and
usually transitory non-clinical bipolar phenotype.
A disorder of self-monitoring may underlie the positive symptoms of
psychosis. The cognitive mechanisms associated with these symptoms may
also be detectable in individuals at risk of psychosis
To investigate (a) whether patients with psychosis show impaired
self-monitoring, (b) to what degree this is associated with positive
symptoms, and (c) whether this is associated with liability to psychotic
The sample included: individuals with a lifetime history of non-affective
psychosis (n=37), a genetically defined risk group
(n=41), a psychometrically defined risk group
(n=40), and control group (n=49).
All participants carried out an action-recognition task
Number of action – recognition errors was associated with psychosis risk
(OR linear trend over 3 levels: 1.12, 95% CI 1.04–1.20) and differential
error rate was associated with the degree of delusional ideation in a
dose–response fashion (OR linear trend over 3 levels: 1.13, 95% CI
Alterations in self-monitoring are associated with psychosis with
evidence of specificity for delusional ideation. In the risk state, this
is expressed more as failure to recognise self-generated actions, whereas
in illness failure to recognise alien sources come to the fore
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