Preventive strategies in bipolar disorders: Identifying targets for early intervention

© Cambridge University Press 2009. Introduction Intervention in the early phases of mental disorders has become a major clinical and research focus and is one of the main challenges facing contemporary mental health. This growing interest has led to the development of new lines of enquiry as well as the implementation of new types of treatment programme and services. In this context, the early phase of psychosis has attracted considerable attention in recent years; the therapeutic strategies that have been developed as a consequence may be beginning to improve the outcome of these conditions (McGorry & Jackson, 1999). Yet, most of the attention has been directed to schizophrenia, probably in reaction to the pessimism traditionally associated with this disorder (Conus & McGorry, 2002). Bipolar disorders, usually considered with more optimism, have been relatively neglected by this movement in comparison with schizophrenia. However, while Kraepelin’s (1919) initial view of mental illness was excessively pessimistic regarding schizophrenia, it was also excessively optimistic regarding manic depression, and the assumption of a generally good outcome in manic depression has now been challenged many times (Conus et al., 2006a; Coryell et al., 1993; Dion et al., 1988; Harrow et al., 1990; Tohen et al., 1990a, 2000a, b). For the many reasons given in this chapter, it is imperative that a preventive approach should also be extended to bipolar disorders. Indeed, it is likely that the key targets of early intervention in psychosis, namely early detection and optimal, intensive and sustained intervention during the early years of illness, are relevant to bipolar disorders.