title: Early stages of bipolar disorder: characterization and strategies for early intervention.
abstract: OBJECTIVE
  To characterize the early stages of bipolar disorder (BD), defined as the clinical prodrome/subsyndromal stage and first-episode phase, and strategies for their respective treatment.
  
  
  METHODS
  A selective literature search of the PubMed, Embase, PsycINFO, and ISI databases from inception until March 2014 was performed. Included in this review were articles that a) characterized prodromal and first-episode stages of BD or b) detailed efficacy and safety/tolerability of interventions in patients considered prodromal for BD or those with only one episode of mania/hypomania.
  
  
  RESULTS
  As research has only recently focused on characterization of the early phase of BD, there is little evidence for the effectiveness of any treatment option in the early phase of BD. Case management; individual, group, and family therapy; supportive therapy; and group psychoeducation programs have been proposed. Most evidence-based treatment guidelines for BD do not address treatment specifically in the context of the early stages of illness. Evidence for pharmacotherapy is usually presented in relation to illness polarity (i.e., manic/mixed or depressed) or treatment phase.
  
  
  CONCLUSIONS
  Although early recognition and treatment are critical to preventing unfavorable outcomes, there is currently little evidence for interventions in these stages of BD.
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Adiel C
authors.initials: AC
authors.lastname: Rios
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Mariane N
authors.initials: MN
authors.lastname: Noto
authors.affiliation: Interdisciplinary Laboratory of Clinical Neurosciences (LINC), Department of Psychiatry, UNIFESP, São Paulo, SP, Brazil.
authors.forename: Lucas B
authors.initials: LB
authors.lastname: Rizzo
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Mansur
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Flávio E
authors.initials: FE
authors.lastname: Martins
authors.affiliation: Developmental Cognitive Neuroscience Research Group (GNCD), Centre of Studies and Research in Traumatic Stress (NEPTE), Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Grassi-Oliveira
authors.affiliation: The Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Health System, Glen Oaks, New York, NY, USA.
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
authors.affiliation: Program for Recognition and Intervention in Individuals in At-Risk Mental States (PRISMA), Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
authors.forename: Elisa
authors.initials: E
authors.lastname: Brietzke
mesh_terms: D001714:Bipolar Disorder / Q000473:pathology* / Q000628:therapy*; D018450:Disease Progression; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome