The McLean-Harvard First-Episode Mania Study: Prediction of Recovery and First Recurrence

Tohen, Mauricio; Zarate, Carlos A.; Hennen, John; Khalsa, Hari Mandir Kaur; Strakowski, Stephen M.; Gebre-Medhin, Priscilla; Salvatore, Paola; Baldessarini, Ross J.

doi:10.1176/appi.ajp.160.12.2099

Cited by 418 publications

(408 citation statements)

References 40 publications

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“…However, a growing number of studies indicate that, for a significant number of patients, outcome is quite poor, with high rates of relapse, chronicity, lingering residual symptoms, subsyndromes, cognitive and functional impairment, psychosocial disability, and diminished well-being. [2][3][4][5] Suicide is estimated to be the cause of death in up to 15% of individuals with mood disorders. In addition to this serious health risk, systemic manifestations of other medical conditions commonly co-occur in patients with a mood disorder.…”

Section: Introductionmentioning

confidence: 99%

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

Carlson¹,

Singh²,

Zarate³

et al. 2006

NeuroRX

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136

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Summary:Major depressive disorder and bipolar disorder are severe mood disorders that affect the lives and functioning of millions each year. The majority of previous neurobiological research and standard pharmacotherapy regimens have approached these illnesses as purely neurochemical disorders, with particular focus on the monoaminergic neurotransmitter systems. Not altogether surprisingly, these treatments are inadequate for many individuals afflicted with these devastating illnesses. Recent advances in functional brain imaging have identified critical neural circuits involving the amygdala and other limbic structures, prefrontal cortical regions, thalamus, and basal ganglia that modulate emotional behavior and are disturbed in primary and secondary mood disorders. Growing evidence suggests that mechanisms of neural plasticity and cellular resilience, including impairments of neurotrophic signaling cascades as well as altered glutamatergic and glucocorticoid signaling, underlie the dysregulation in these circuits. The increasing ability to monitor and modulate activity in these circuits is beginning to yield greater insight into the neurobiological basis of mood disorders. Modulation of dysregulated activity in these affective circuits via pharmacological agents that enhance neuronal resilience and plasticity, and possibly via emerging nonpharmacologic, circuitry-based modalities (for example, deep brain stimulation, magnetic stimulation, or vagus nerve stimulation) offers promising targets for novel experimental therapeutics in the treatment of mood disorders.

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Section: Introductionmentioning

confidence: 99%

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

Carlson¹,

Singh²,

Zarate³

et al. 2006

NeuroRX

Self Cite

136

View full text Add to dashboard Cite

show abstract

“…32 A recent study from the Systematic Treatment Optimization Program for Early Mania Project (STOP-EM) recruited a cohort of patients with BD type I without psychosis (n=53). 31 Almost 90% achieved syndromic recovery and 53% had symptom recurrence during 1-year follow-up (Table 2). Functional outcomes were not reported.…”

Section: First Episode Of Mania (Stage Ii)mentioning

confidence: 97%

“…Psychotic features, low premorbid occupational status, and non-mixed initial mania were related to new manic episodes, while higher occupational achievement, initial mixed dysphoric states, and psychiatric or medical comorbidity were associated with new depressive episodes ( Table 3). 31 In a cohort of 87 patients with first-episode psychotic mania, Conus et al found 90% syndromic, 60% symptomatic, and 39% functional recovery at 12-month follow-up. 7 Patients without family history of affective disorders, without substance use, and older age were more likely to achieve functional recovery after 12 months.…”

Section: First Episode Of Mania (Stage Ii)mentioning

confidence: 98%

“…29,30 Over time, there is a propensity to progression of psychopathology, and symptoms usually become more specific and more similar to those of full BD. 30,31 Accordingly, a 4-year follow-up prospective study found that 38% of children and adolescents initially diagnosed with BD not otherwise specified and 25% of those diagnosed with BD type II transitioned to BD type I. 23 At least one depressive episode frequently precedes the onset of mania and is commonly treated with antidepressant medications, regardless of the risk for developing BD.…”

Section: Prodromal Period Of First Manic Episode (Stage I)mentioning

confidence: 99%

“…42 Psychotherapeutic interventions have an exceptionally favorable benefit/risk ratio and are therefore Recurrence of depression Initial mixed dysphoric states and psychiatric or medical comorbidity. Tohen 31 …”

Section: Non-pharmacologicalmentioning

confidence: 99%

See 2 more Smart Citations

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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Clinical Trials in Bipolar Mania

Tohen¹

2008

Arch Gen Psychiatry

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The McLean-Harvard First-Episode Mania Study: Prediction of Recovery and First Recurrence

Cited by 418 publications

References 40 publications

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

Neural circuitry and neuroplasticity in mood disorders: Insights for novel therapeutic targets

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

Clinical Trials in Bipolar Mania

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