Ethical considerations in preventive interventions for bipolar disorder

Abstract

Concerns about the risks of early identification and pre-onset interventions should be balanced against the potential benefits, the individuals' right to choice and by improving availability of services that balance such dilemmas.

Should we intervene at stage 0? A qualitative study of attitudes of asymptomatic youth at increased risk of developing bipolar disorders and parents with established disease

“…The findings from our interviews with PBD offer some support for the validity of our methodology as they reflect findings from qualitative and quantitative studies (Gershon, ; Hippman et al, ; Meiser et al, ; Meiser et al, ; Meiser et al, ; Peay et al, ; Quinn et al, ; Ratheesh et al, ; Shaw et al, ). A feature of the PBD interviews was ignorance of the role or accuracy of genetic testing in complex diseases or the psychological consequences of testing (Ryan et al, ; Salkovskis & Rimes, ).…”

“…First, we undertook a selective literature review of publications that were potentially relevant to the planned interviews (Hippman et al, 2016;Meiser et al, 2008;Peay, Rosenstein, & Biesecker, 2013;Ratheesh et al, 2016;Ryan, Virani, & Austin, 2015;Shaw, Abrams, & Marteau, 1999;Vallarino et al, 2015;Welsh & Tiffin, 2015) (see Supporting Information) and identified topics that could be incorporated into open-ended questions (if necessary) to help promote discussions.…”

“…A review of the literature (Callahan, Liu, Purcell, Parker, & Hetrick, 2012;Catalano, Hawkins, Berglund, Pollard, & Arthur, 2002;DuBois, Portillo, Rhodes, Silverthorn, & Valentine, 2011;Meiser et al, 2013;Potter et al, 2012;Quinn et al, 2014;Ratheesh et al, 2016) suggests that there are no studies explicitly examine interventions for individuals who are "asymptomatic but at increased risk of BD," nor whether youth would welcome any interventions. Currently, the only BAR sub-population who can be reliably classified as being at stage 0 are the asymptomatic offspring of a parent with BD (OSBD) (Duffy et al, 2011;Rasic, Hajek, Alda, & Uher, 2014;Vallarino et al, 2015).…”

Is “early intervention” in bipolar disorder what it claims to be?

“…The potential advantages to be gained from intervening promptly have driven the development of clinical staging models for BD, which aim to provide a framework for the emergence of the disorder. Clinical staging is purported to be a more sophisticated form of diagnosis, which attempts to position an individual along the continuum of disease progression and directs clinicians to stage‐appropriate interventions . Inherent in the staging model is the assumption that the course of the illness is unidirectional and progressive .…”

“…As such, staging models have been applied successfully for chronic physical disorders (e.g. in oncology) and have lately been adopted for some psychiatric illnesses, such as psychosis and more recently BD, with the aim to identify at‐risk periods and deliver targeted stage‐aligned treatments …”