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

Abstract

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.

Metabolic parameters as possible diagnostic predictors in first‐episode psychosis: An exploratory retrospective cohort study

“…Nonetheless, there are no well‐established biomarkers to predict the risk of conversion to SCZ or affective psychosis ‐ bipolar disorder (BD) or schizoaffective disorder (SZA) ‐ in patients with first‐episode psychosis (FEP). Although several candidate peripheral biomarkers have been proposed for BD (Brietzke et al, 2016) and SCZ (e.g., BDNF, IL‐2, TNF, or pentosidine), these parameters are mostly unavailable in routine clinical practice (Lai et al, 2016).…”

BDNF and BMI effects on brain structures of bipolar offspring: results from the global mood and brain science initiative

“…Staging studies of bipolar disorder (BD) in offspring and selecting at‐risk samples provide significant insights into the neurobiology of the early stages of BD . The identification of clinical, cellular, and molecular underpinnings of preclinical stages has the potential to inform putatively preventive interventions, particularly those designed to delay, reduce the severity of, or even prevent the onset of full‐blown BD .…”

1H-NMR, 1H-NMR T2-edited, and 2D-NMR in bipolar disorder metabolic profiling

“…Increased accuracy in early diagnosis of BD is the key to improve the mental health outcomes, to ameliorate the clinical course, and to make better the treatment response of patients with this disorder. However, the diagnosis of BD, especially in early stages and in predominantly depressive presentations, remains challenging (Brietzke et al 2016 ). These challenges could possibly be overcome by the identification of differentially expressed biomarkers, which could reflect or convey the pathophysiological processes (Oswald et al 2007 ; Marmol 2008 ).…”