Early Intervention in Bipolar Disorder
Open accessAbstract
Bipolar disorder is a recurrent disorder that affects more than 1% of the world population and usually has its onset during youth. Its chronic course is associated with high rates of morbidity and mortality, making bipolar disorder one of the main causes of disability among young and working-age people. The implementation of early intervention strategies may help to change the outcome of the illness and avert potentially irreversible harm to patients with bipolar disorder, as early phases may be more responsive to treatment and may need less aggressive therapies. Early intervention in bipolar disorder is gaining momentum. Current evidence emerging from longitudinal studies indicates that parental early-onset bipolar disorder is the most consistent risk factor for bipolar disorder. Longitudinal studies also indicate that a full-blown manic episode is often preceded by a variety of prodromal symptoms, particularly subsyndromal manic symptoms, therefore supporting the existence of an at-risk state in bipolar disorder that could be targeted through early intervention. There are also identifiable risk factors that influence the course of bipolar disorder, some of them potentially modifiable. Valid biomarkers or diagnosis tools to help clinicians identify individuals at high risk of conversion to bipolar disorder are still lacking, although there are some promising early results. Pending more solid evidence on the best treatment strategy in early phases of bipolar disorder, physicians should carefully weigh the risks and benefits of each intervention. Further studies will provide the evidence needed to finish shaping the concept of early intervention. AJP AT 175 Remembering Our Past As We Envision Our Future April 1925: Interpretations of Manic-Depressive Phases Earl Bond and G.E. Partridge reviewed a number of patients with manic-depressive illness in search of a unifying endo-psychic conflict. They concluded that understanding either phase of illness was "elusive" and "tantalizing beyond reach." (Am J Psychiatry 1925: 81: 643-662 ).
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More recent evidence suggests that response to treatment is best after the first episode and declines thereafter, and this decline is associated with a potentially neuroprogressive process with substantial clinical and functional sequelae.
“More recent evidence suggests that the response to treatment is best after the first episode [34] and declines thereafter, and this decline is associated with a potentially neuroprogressive process with substantial clinical and functional sequelae [35, 36].”
From Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies (2020) · cites this paper as [35]
The ‘Exploring Early Treatment Strategies in Bipolar Disorder’ section says lithium is more effective when started early and psychosocial interventions may have greater efficacy earlier in the illness course. The ‘Summary and Future Directions’ section describes progression toward a late, resistant stage, but the paper does not establish that response is best specifically after the first episode or link declining response to a neuroprogressive process with clinical and functional sequelae. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIndicated prevention in bipolar disorder was developed only fifteen years ago and is rapidly emerging, but its supporting evidence lags behind that for CHR-P.
“Indicated prevention in bipolar disorder was developed, following the CHR-P template, only fifteen years ago 96,97 , and is rapidly emerging 98-101 . The supporting evidence lags behind that for CHR-P 99,102 .”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [99]
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References 143 · Cited by 354
Research works printed but not linked: 11
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- Authors
- Vieta, E., Salagre, E., Grande, I., Carvalho, A. F., Fernandes, B. S., Berk, M., Birmaher, B., Tohen, M., & Suppes, T.
- Affiliations
- Barwon Health (AU)
- From the Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; the Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil; the Centre for Innovation in Mental and Physical Health and Clinical Treatment and Barwon Health, School of Medicine, Deakin University, Geelong,...
- Venue
- American Journal of Psychiatry
- Published
- 2018-05-01
- Volume
- 175
- Issue
- 5
- Pages
- 411-426
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2789768691
- Cited by
- 354
- References
- 143
- Citations by year
- 2026: 37 · 2025: 54 · 2024: 42 · 2023: 42 · 2022: 44 · 2021: 39 · 2020: 35 · 2019: 41 · 2018: 19 · 2017: 1
- FWCI
- 5.17
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Sanofi
- Teva Pharmaceutical Industries
- Stanley Medical Research Institute
- Geelong Region Medical Research Foundation
- Sunovion
- Deakin University (1059660)
- Ministerio de Economía y Competitividad (PI16/, PI16/00187)
- Gedeon Richter
- Ministério da Ciência, Tecnologia e Inovação
- Conselho Nacional de Desenvolvimento Científico e Tecnológico (2014‐0)
- Centro de Investigación Biomédica en Red de Salud Mental
- Servier
- H. Lundbeck A/S
- Allergan
- Medical Research Council
- National Health and Medical Research Council (1059660)
- Instituto de Salud Carlos III (PI16/, 00012, JR15/00012, PI16/00187)
- European Regional Development Fund
- National Institute of Mental Health (1059660)
- Cilag
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Keywords
- bipolar disorder, early intervention, prodromal symptoms, familial risk, risk factors, biomarkers, conversion to bipolar disorder
- MeSH terms
- Adolescent, Adult, Bipolar Disorder, Child, Humans, Mass Screening, Psychiatric Status Rating Scales, Risk Factors, Biomarkers, Genetic Predisposition to Disease, Early Diagnosis, Young Adult, Early Medical Intervention, Prodromal Symptoms
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