Evidence and implications for early intervention in bipolar disorder.
OBJECTIVE
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.
Berk
Michael
M
Department of Clinical and Biomedical Sciences, University of Melbourne, Parkville, Australia. mikebe@barwonhealth.org.au
Hallam
Karen
K
Malhi
Gin S
GS
Henry
Lisa
L
Hasty
Melissa
M
Macneil
Craig
C
Yucel
Murat
M
Pantelis
Chris
C
Murphy
Brendan
B
Vieta
Eduard
E
Dodd
Seetal
S
McGorry
Patrick D
PD
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000928:Antidepressive Agents / Q000627:therapeutic use; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D001921:Brain / Q000033:anatomy & histology / Q000503:physiopathology; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D004565:Electroconvulsive Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D011584:Psychology; D011613:Psychotherapy / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors
D000928:Antidepressive Agents; D018692:Antimanic Agents