title: From neuroprogression to neuroprotection: implications for clinical care.
abstract: Bipolar disorder follows a staged trajectory in which persistence of illness is associated with a number of clinical features such as progressive shortening of the inter-episode interval and decreased probability of treatment response. This neuroprogressive clinical process is reflected by both progressive neuroanatomical changes and evidence of cognitive decline. The biochemical foundation of this process appears to incorporate changes in inflammatory cytokines, cortisone, neurotrophins and oxidative stress. There is a growing body of evidence to suggest that these markers may differ between the early and late stages of the disorder. The presence of a series of tangible targets raises the spectre of development of rational neuroprotective strategies, involving judicious use of current therapies and novel agents. Most of the currently used mood stabilisers share effects on oxidative stress and neurotrophins, while novel potentially neuroprotective agents are being developed. These developments need to be combined with service initiatives to maximise the opportunities for early diagnosis and intervention.
authors: Department of Clinical and Biomedical Sciences-Barwon Health, University of Melbourne, Melbourne, VIC. mikebe@barwonhealth.org.au
authors: Michael
authors: M
authors: Berk
authors: Philippe
authors: P
authors: Conus
authors: Flávio
authors: F
authors: Kapczinski
authors: Ana C
authors: AC
authors: Andreazza
authors: Murat
authors: M
authors: Yücel
authors: Stephen J
authors: SJ
authors: Wood
authors: Christos
authors: C
authors: Pantelis
authors: Gin S
authors: GS
authors: Malhi
authors: Seetal
authors: S
authors: Dodd
authors: Andreas
authors: A
authors: Bechdolf
authors: G Paul
authors: GP
authors: Amminger
authors: Ian B
authors: IB
authors: Hickie
authors: Patrick D
authors: PD
authors: McGorry
mesh_terms: D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000503:physiopathology*; D001921:Brain / Q000033:anatomy & histology / Q000503:physiopathology*; D003072:Cognition Disorders / Q000503:physiopathology; D018450:Disease Progression; D006801:Humans; D008928:Mitochondria / Q000502:physiology; D009414:Nerve Growth Factors / Q000502:physiology; D018696:Neuroprotective Agents / Q000627:therapeutic use; D018384:Oxidative Stress / Q000502:physiology
chemical_list: D018692:Antimanic Agents; D009414:Nerve Growth Factors; D018696:Neuroprotective Agents