title: Refractory bipolar disorder and neuroprogression.
abstract: Immune activation and failure of physiologic compensatory mechanisms over time have been implicated in the pathophysiology of illness progression in bipolar disorder. Recent evidence suggests that such changes are important contributors to neuroprogression and may mediate the cross-sensitization of episode recurrence, trauma exposure and substance use. The present review aims to discuss the potential factors related to bipolar disorder refractoriness and neuroprogression. In addition, we will discuss the possible impacts of early therapeutic interventions as well as the alternative approaches in late stages of the disorder.
authors.affiliation: UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA.
authors.forename: Sabrina C
authors.initials: SC
authors.lastname: da Costa
authors.affiliation: UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA; Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Ives C
authors.initials: IC
authors.lastname: Passos
authors.affiliation: UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lowri
authors.affiliation: UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA.
authors.forename: Jair C
authors.initials: JC
authors.lastname: Soares
authors.affiliation: UT Center of Excellence on Mood Disorder, Department of Psychiatry and Behavioral Sciences, The University of Texas Science Center at Houston, Houston, TX, USA; Bipolar Disorder Program and Laboratory of Molecular Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil. Electronic address: flavio.kapczinski@gmail.com.
authors.forename: Flavio
authors.initials: F
authors.lastname: Kapczinski
mesh_terms: D000818:Animals; D001714:Bipolar Disorder / Q000503:physiopathology* / Q000628:therapy*; D018450:Disease Progression; D004351:Drug Resistance / Q000502:physiology; D006801:Humans
keywords: Bipolar disorder; Neuroprogression; Sensitization/cross-sensitization; Therapeutic interventions; Treatment refractoriness