title: Public health significance of bipolar disorder: implications for early intervention and prevention.
abstract: OBJECTIVE
  Early intervention and preventive strategies have become major targets of research and service development in psychiatry over the last few years. Compared to schizophrenia, bipolar disorder (BD) has received limited attention in this regard. In this paper, we review the available literature in order to explore the public health significance of BD and the extent to which this may justify the development of early intervention strategies for this disorder.
  
  
  METHODS
  The main computerized psychiatric literature databases were accessed. This included Medline and PsychInfo, using the following keywords: bipolar, early intervention, staging model, burden, caregiver, public health, and manic depression.
  
  
  RESULTS
  BD is often recurrent and has an impact that goes well beyond symptomatic pathology. The burden it incurs is linked not only to its cardinal clinical features, but also to cognitive dysfunction, poor functional outcome, poor physical health, high rate of comorbidities, and suicide. At a societal level, BD induces enormous direct and indirect costs and has a major impact on caregivers. The available literature reveals a usually long delay between illness onset and the start of treatment, and the absence of specific guidelines for the treatment of the early phase of BD.
  
  
  CONCLUSIONS
  Considering the major impact of BD on patients and society, there is an urgent need for the development of early intervention strategies aimed at earlier detection and more specific treatment of the early phase of the disorder.
authors.affiliation: Service de Psychiatrie Générale, Département Universitaire de Psychiatrie CHUV, Lausanne University, Clinique de Cery, Prilly, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Conus
authors.forename: Craig
authors.initials: C
authors.lastname: Macneil
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
mesh_terms: D035843:Biomedical Research; D001714:Bipolar Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D018479:Early Intervention, Educational; D006801:Humans; D011634:Public Health
keywords: bipolar disorder; burden; early intervention; public health