title: Early intervention in bipolar disorders: clinical, biochemical and neuroimaging imperatives.
abstract: In the absence of clear targets for primary prevention of many psychiatric illnesses, secondary prevention becomes the most feasible therapeutic target, and is best encompassed by the concept of early intervention. This construct encompasses the goals of minimising diagnostic delay and the prompt initiation of clinically appropriate therapy. This paper develops the rationale for early intervention in bipolar disorder. Three interrelated themes are discussed; the clinical data supporting the value of prompt diagnosis and treatment in bipolar disorder, the putative biochemical mechanisms underlying the pathophysiological processes, and the parallel concept of neuroprotection, and the developing neuroimaging data that supports early intervention. Early initiation of appropriate therapy may potentially facilitate improved clinical outcomes, and further might allow the secondary prevention of the sequelae of untreated illness, which include the deleterious impact on family relationships, psychosexual and vocational development, identity and self-concept and self-stigma.
authors.affiliation: Department of Clinical and Biomedical Sciences, University of Melbourne, PO Box 281, Geelong, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.forename: Gin S
authors.initials: GS
authors.lastname: Malhi
authors.forename: Karen
authors.initials: K
authors.lastname: Hallam
authors.forename: Clarissa S
authors.initials: CS
authors.lastname: Gama
authors.forename: Seetal
authors.initials: S
authors.lastname: Dodd
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Andreazza
authors.forename: Benício N
authors.initials: BN
authors.lastname: Frey
authors.forename: Flavio
authors.initials: F
authors.lastname: Kapczinski
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D019208:Brain-Derived Neurotrophic Factor / Q000378:metabolism; D003952:Diagnostic Imaging / Q000379:methods / Q000639:trends; D042241:Early Diagnosis; D006801:Humans; D018384:Oxidative Stress / Q000187:drug effects; D013997:Time Factors
chemical_list: D015415:Biomarkers; D019208:Brain-Derived Neurotrophic Factor