Evidence and implications for early intervention in bipolar disorder

Berk, Michael, Hallam, Karen, Mahli, Gin S., Henry, Lisa, Hasty, Melissa, Macneil, Craig, Yucel, Murat, Pantelis, Chris, Murphy, Brendan, Vieta, Eduard, Dodd, Seetal and McGorry, Patrick D 2010, Evidence and implications for early intervention in bipolar disorder, Journal of mental health, vol. 19, no. 2, pp. 113-126.

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Title Evidence and implications for early intervention in bipolar disorder
Author(s) Berk, Michael
Hallam, Karen
Mahli, Gin S.
Henry, Lisa
Hasty, Melissa
Macneil, Craig
Yucel, Murat
Pantelis, Chris
Murphy, Brendan
Vieta, Eduard
Dodd, Seetal
McGorry, Patrick D
Journal name Journal of mental health
Volume number 19
Issue number 2
Start page 113
End page 126
Total pages 14
Publisher Routledge
Place of publication Abingdon, England
Publication date 2010-04
ISSN 0963-8237
1360-0567
Keyword(s) diagnosis
neuroprotection
mania depression
bipolar disorders
early intervention
Summary Aims: To review the evidence that supports early intervention in the treatment of bipolar disorder.

Background: Bipolar disorder is a pleomorphic condition, with varying manifestations that are determined by a number of complex factors including the ‘‘stage’’ of illness. It is consequently a notoriously difficult illness to diagnose and as a corollary is associated with lengthy delays in recognition and the initiation of suitable treatment.

Methods: A literature search was conducted using MEDLINE augmented by a manual search.

Results: Emerging neuroimaging data suggests that, in contrast to schizophrenia, where at the time of a first-episode of illness there is already discernible volume loss, in bipolar disorder, gross brain structure is relatively preserved, and it is only with recurrences that there is a sequential, but marked loss of brain volume. Recent evidence suggests that both pharmacotherapy and psychotherapy are more effective if instituted early in the course of bipolar disorder, and that with multiple episodes and disease progression there is a noticeable decline in treatment response.

Conclusions: Such data supports the notion of clinical staging, and the tailored implementation of treatments according to the stage of illness. The progressive nature of bipolar disorder further supports the concept that the first episode is a period that requires energetic broad-based treatment, with the hope that this could alter the temporal trajectory of the illness. It also raises hope that prompt treatment may be neuroprotective and that this perhaps attenuates or even prevents the neurostructural and neurocognitive changes seen to emerge with chronicity. This highlights the need for early identification at a population level and the necessity of implementing treatments and services at a stage of the illness where prognosis is optimal.
Language eng
Field of Research 129999 Built Environment and Design not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2010, Informa UK
Persistent URL http://hdl.handle.net/10536/DRO/DU:30035551

Document type: Journal Article
Collection: School of Medicine
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