Staging and Neuroprogression in Bipolar Disorder: A Systematic Review of the Literature

Section: Introductionmentioning

confidence: 83%

Pharmacological treatment and staging in bipolar disorder: evidence from clinical practice

Goi

Bücker

Vianna-Sulzbach

et al. 2015

“…10 Biomarkers seem to play an important role in evaluating disease activity and progression associated with different mood states (mood biomarkers), as well as to identify specific characteristics of the disease (trait biomarkers). 11,12 The available evidence indicates that neurotrophins, oxidative stress, and inflammation are linked to the acute and euthymic phases of BD, 13,14 and indicate the presence of systemic toxicity. 15 The use of clinical staging models is emerging as a novel and useful paradigm to inform diagnosis and treatment of BD.…”

Section: Introductionmentioning

confidence: 99%

“…7,[19][20][21] The term neuroprogression has been increasingly used to define the pathological reorganization of the central nervous system (CNS) that occurs over the course of severe mental disorders. 12 This reorganization may arise as the result of several ''insults,'' such as inflammation and oxidative stress. 12 To refine clinical staging models and identify novel, specific targets for early intervention, it is essential to understand the pathophysiological processes associated with the clinical stages of illness development.…”

Section: Introductionmentioning

confidence: 99%

Challenges and developments in research of the early stages of bipolar disorder

Brietzke

Rosa

Pedrini

et al. 2016

Self Cite

Recently, attention in the field of bipolar disorder (BD) has focused on prevention, including early detection and intervention, as these strategies have the potential to delay, lessen the severity, or even prevent full-blown episodes of BD. Although knowledge of the neurobiology of BD has advanced substantially in the last two decades, most research was conducted with chronic patients. The objective of this paper is to comprehensively review the literature regarding the early stages of BD, to explore recent discoveries on the neurobiology of these stages, and to discuss implications for research and clinical care. The following databases were searched: PubMed, PsycINFO, Cochrane Library, and SciELO. Articles published in English from inception to December 2015 were retrieved. Several research approaches were used, including examination of offspring studies, retrospective studies, prospective studies of clinical high-risk populations, and exploration of the progression after the first manic episode. Investigations with neuroimaging, cognition assessments, and biomarkers provide promising (although not definitive) evidence of alterations in the neural substrate during the at-risk stage. Research on BD should be expanded to encompass at-risk states and aligned with recent methodological progress in neuroscience.

“…1 Recently, however, this view has been challenged by findings that, at least for a large group of individuals, the disease follows a chronic, unremitting, and deteriorating course. 2,3 Clinical and preclinical data show that treatment delay and/or exposure to a high number of mood episodes are associated with a worse clinical course. 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.…”

Section: Introductionmentioning

confidence: 99%

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

Rios

Noto

Rizzo

et al. 2015

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.