Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention

Berk, Michael; Brnabic, Alan; Dodd, Seetal; Kelin, Katarina; Tohen, Mauricio; Malhi, Gin S; Berk, Lesley; Conus, Philippe; McGorry, Patrick D.

doi:10.1111/j.1399-5618.2011.00889.x

Cited by 178 publications

(159 citation statements)

References 49 publications

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“…Similarly, a clinical trial of cognitive behavioral therapy showed that only patients who had fewer than 12 episodes of illness improved [10]. Moreover, a study showed that response rates for olanzapine in acute mood episodes or during the maintenance phase were significantly higher among individuals with less than five previous episodes [11]. In addition, a study with thirty-five treatment-resistant patients with bipolar disorder reported that response to lamotrigine monotherapy was associated with fewer hospitalizations [12].…”

Section: Treatment Refractorinessmentioning

confidence: 99%

Should bipolar disorder treatment be modified depending on staging?

Passos

Kapczinski

2016

Expert Review of Neurotherapeutics

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Section: Treatment Refractorinessmentioning

confidence: 99%

Should bipolar disorder treatment be modified depending on staging?

Passos

Kapczinski

2016

Expert Review of Neurotherapeutics

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“…Os efeitos progressivos no sistema nervoso central (SNC), assim como interações entre centro e periferia, são o enfoque escolhido pelo professor Berk, na Austrália, com destaque para "neuroproteção" e "neuroprogressão" 2,17 . Isso se alinha a dados recentes que sugerem que alguma versão de estadiamento clínico possa ser útil para prescrição individual de tratamento [18][19][20] .…”

Section: Introductionunclassified

Marcadores periféricos e a fisiopatologia do transtorno bipolar

Magalhães¹,

Fries²,

Kapczinski³

2012

Rev. psiquiatr. clín.

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Introdução: O entendimento da fisiopatologia do transtorno bipolar vem tendo avanços consistentes nos últimos anos. Um enfoque na relação entre carga alostática e alterações sistêmicas vem tomando corpo, com o objetivo de se entender a frequente progressão da doença. Proeminentes entre os mediadores periféricos têm sido as moléculas que poderiam ser amplamente agrupadas em neurotrofinas, marcadores de estresse oxidativo e marcadores inflamatórios. Objetivo: Descrever achados recentes em relação à fisiopatologia sistêmica do transtorno bipolar, com enfoque especial em estudos brasileiros, tentando articular uma visão coerente do conhecimento atual do campo. Método: Revisão narrativa da literatura relacionada a neurotrofinas, estresse oxidativo e marcadores inflamatórios no transtorno bipolar. Resultados: Diversas fontes de evidência, provenientes tanto de estudos pré-clínicos quanto clínicos, revelam consistentemente alterações sistêmicas no transtorno bipolar. Os achados são especialmente robustos em pacientes com múltiplos episódios. Nesses, alterações relacionadas a episódios de mania e depressão são notáveis em neurotrofinas e dano oxidativo a lipídeos. Um número menor de estudos mostra alterações no sistema imune, em particular estados pró-inflamatórios. Conclusão: Alterações sistêmicas que correlacionam o transtorno bipolar a comorbidade clínica, disfunção cognitiva, incapacidade e mortalidade precoce começam a ser traçadas. Estudos envolvendo desenhos longitudinais, amostras populacionais e ensaios clínicos envolvendo marcadores periféricos devem ser incorporados no futuro próximo e reforçar a validade de uma noção de envolvimento multissistêmico no transtorno bipolar.Magalhães PVS, et al. / Rev Psiq Clín. 2012;39(2):60-7 Palavras-chave: Transtorno bipolar, inflamação, estresse oxidativo, neurotrofinas, fator neurotrófico derivado do cérebro, fisiopatologia, biomarcadores. ABSTRACT Introduction:The understanding of the pathophysiology of bipolar disorder has steadily advanced in the past few years. Thereby, a focus on allostatic load and systemic changes has appeared, with the aim to understand illness progression. Amongst the peripheral markers, molecules that can be widely classified into neurotrophins, oxidadive stress markers, and inflammation markers have been elevated. Objective: To describe recent findings regarding the systemic pathophysiology of bipolar disorder, with a special focus on Brazilian studies and to create a coherent view of the current knowledge in the field. Method: Narrative review of the literature regarding neurotrophins, oxidative stress, and inflammatory markers in bipolar disorder. Results: A diverse body of evidence, based on both pre-clinical and clinical studies, reveals consistent systemic changes in bipolar disorder. The findings are particularly robust in patients after multiple episodes. Thereby, remarkable changes related to manic and depressive episodes were found in neurotrophins and oxidative damage to lipids. Regarding to immune system alterations, in particular pro...

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“…7 There is substantial evidence that the number of previous affective episodes is a risk factor for episode recurrence, chronicity, and suicide; thus, appropriate early treatment would likely decrease the risk of these negative outcomes. 6 Most evidence-based BD guidelines do not address treatment specifically in the context of the early stages.…”

Section: Psychopharmacologicalmentioning

confidence: 99%

“…Because issues of recovery can significantly affect disability, quality of life, and outcome, early intervention for first-episode individuals with BD is clearly an important objective. 6 An assessment of quality of life after recovery from a first manic episode indicated that quality of life is related to length of illness and severity of depressive symptoms at both baseline and 6 months, as well as to the number of depressive episodes (Table 3), 40 indicating a need for aggressive treatment of depressive symptoms in this population.…”

Section: First Episode Of Mania (Stage Ii)mentioning

confidence: 99%

“…4,5 This effect can be observed on a number of outcomes, including shortening of inter-episodic interval, persistence of subsyndromal symptoms, cognitive deficits, higher number of hospitalizations, emergence of medical and psychiatric comorbidities, increased suicide risk, worse social adjustment, and poor quality of life. [6][7][8][9][10] Moreover, treatment response also appears to change as a function of episode frequency, as both pharmacological agents (e.g., lithium, olanzapine) and psychosocial interventions (e.g., psychoeducation, cognitive-behavioral therapy) seem less effective in multiepisodic BD. 11,12 The clinical progression described above is hypothesized to be subserved by neurobiological changes, the so-called neuroprogression.…”

Section: Introductionmentioning

confidence: 99%

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Early stages of bipolar disorder: characterization and strategies for early intervention

Rios

Noto

Rizzo

et al. 2015

Rev. Bras. Psiquiatr.

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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.

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Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention

Abstract: Those individuals at the earliest stages of illness consistently had a more favourable response to treatment. This is consistent with the staging model and underscores the need to support a policy of early intervention.

Cited by 178 publications

References 49 publications

Should bipolar disorder treatment be modified depending on staging?

Should bipolar disorder treatment be modified depending on staging?

Marcadores periféricos e a fisiopatologia do transtorno bipolar

Early stages of bipolar disorder: characterization and strategies for early intervention

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