Early intervention for bipolar disorder: current imperatives, future directions

Taylor, Matthew; Bressan, Rodrigo A.; Neto, Pedro Pan; Brietzke, Elisa

doi:10.1590/s1516-44462011000600006

Cited by 17 publications

(5 citation statements)

References 82 publications

(41 reference statements)

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“…Delays in identification and treatment may lead to adverse outcomes, such as erroneous pharmacological interventions. 4 New approaches to assessing manic symptoms could facilitate the identification of BD in youth.…”

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confidence: 99%

Manic Symptoms in Youth: Dimensions, Latent Classes, and Associations With Parental Psychopathology

Pan

Salum

Gadelha

et al. 2014

Journal of the American Academy of Child & Adolescent Psych

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Objective The purpose of the study was to define the latent structure of parent-reported manic symptoms and their association with functional impairment and familial risk in a community sample of Brazilian children. Method We screened for manic symptoms in a community sample of 2,512 children 6 to 12 years of age. Parents of children with “episodes of going abnormally high” completed a detailed mania section (n = 479; 19.1%). Confirmatory factor analysis (CFA) tested a solution with “Under-Control (UC)” and “Exuberant (EX)” dimensions, investigating the severity (threshold) and factor loading of each symptom. We also used latent class analysis (LCA) to evaluate the latent categorical structure of manic symptoms. Associations of these latent constructs with psychiatric comorbidity, psychosocial impairment, and family history of psychopathology were tested. Results The 2-dimensional model fit the data well. Only the UC dimension was associated with psychiatric morbidity, psychosocial impairment, and a family history of mania, depression, or suicide attempts. Both UC and EX items discriminated subjects with “episodes of going abnormally high,” but EX items lay at the mild end of the severity spectrum, whereas UC items lay at the severe end. The LCA yielded a small group of children with high levels of manic symptoms and a distinct profile of psychiatric comorbidity and impairment (“high-symptom group”). Conclusion In a large, community-based sample, we found a 2-dimensional latent structure for parent-reported manic symptoms in youth, and demonstrated familial associations between the UC dimension and affective disorders. Both UC and EX items are clinically useful, but their contributions vary with symptom severity.

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confidence: 99%

Manic Symptoms in Youth: Dimensions, Latent Classes, and Associations With Parental Psychopathology

Pan

Salum

Gadelha

et al. 2014

Journal of the American Academy of Child & Adolescent Psych

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“…4,5 The notion that BD is a condition that follows a reasonable, predictable course across stages was a key aspect in developing proposals for prevention and early intervention. 6 Indeed, there are consistent data suggesting that, at least for a large subgroup of patients, BD actually follows a progressive course, which can be observed both in clinical outcomes (such as functional impairment) and in neurobiological findings (such as structural brain damage). 7,8 According to these models, the disorder starts during the ''at-risk period'' and progresses from the first mood episode through to late-stage disease, where symptoms are more chronic, pervasive, and treatment-resistant, and putatively caused by brain changes related to the action of neurotoxic mediators and reduction of neurotrophic and neuroprotective support.…”

Section: Introductionmentioning

confidence: 93%

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

Brietzke

Rosa

Pedrini

et al. 2016

Rev. Bras. Psiquiatr.

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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.

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“…93 As seen above, cognitive work is energetically demanding 79 ; consequentially, based on our hypothesis, 23 In fact, there is currently a major ongoing effort in psychiatric research to optimize early recognition and diagnosis of schizophrenia and BD, including the identification of prodromal states. 97,98 Studies focusing on pre-clinical stages, the so-called "atrisk mental states," are successfully developing criteria to reliably identify those individuals. 97 Intervention studies have also been conducted in an attempt to prevent the development of a full-blown, clinical illness.…”

Section: Clinical Implications Of Brain Energy Metabolism Dysfunctionmentioning

confidence: 99%

The "selfish brain" hypothesis for metabolic abnormalities in bipolar disorder and schizophrenia

Mansur

Brietzke

2012

Trends Psychiatry Psychother.

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A hipótese do "cérebro egoísta" para alterações metabólicas no transtorno bipolar e na esquizofreniaThe "selfish brain" hypothesis for metabolic abnormalities in bipolar disorder and schizophrenia AbstractMetabolic abnormalities are frequent in patients with schizophrenia and bipolar disorder (BD), leading to a high prevalence of diabetes and metabolic syndrome in this population. Moreover, mortality rates among patients are higher than in the general population, especially due to cardiovascular diseases. Several neurobiological systems involved in energy metabolism have been shown to be altered in both illnesses; however, the cause of metabolic abnormalities and how they relate to schizophrenia and BD pathophysiology are still largely unknown. The "selfish brain" theory is a recent paradigm postulating that, in order to maintain its own energy supply stable, the brain modulates energy metabolism in the periphery by regulation of both allocation and intake of nutrients. We hypothesize that the metabolic alterations observed in these disorders are a result of an inefficient regulation of the brain energy supply and its compensatory mechanisms. The selfish brain theory can also expand our understanding of stress adaptation and neuroprogression in schizophrenia and BD, and, overall, can have important clinical implications for both illnesses. Keywords: Schizophrenia, bipolar disorder, metabolism, brain metabolism, stress, allostasis. ResumoAlterações metabólicas são frequentes em pacientes com esquizofrenia e transtorno bipolar (TB), levando a uma alta prevalên-cia de diabetes e síndrome metabólica nessa população. Além disso, as taxas de mortalidade entre pacientes são mais altas do que na população geral, especialmente em decorrência de doenças cardiovasculares. Vários sistemas neurobiológicos envolvidos no metabolismo energético têm demonstrado alterações nas duas doenças; no entanto, a causa das alterações metabó-licas e a forma como elas se relacionam com a fisiopatologia da esquizofrenia e do TB ainda são arenas em grande parte desconhecidas. A teoria do "cérebro egoísta" é um paradigma recente que postula que, para manter estável seu próprio fornecimento de energia, o cérebro modula o metabolismo da energia na periferia regulando tanto a alocação quanto a ingestão de nutrientes. Apresentamos neste artigo a hipótese de que as alterações metabólicas observadas nesses transtornos são resultado de uma regulação ineficiente do fornecimento de energia do cérebro e seus mecanismos compensatórios. A teoria do cérebro egoísta também pode expandir nosso entendimento sobre a adaptação ao estresse e a neuroprogressão na esquizofrenia e no TB, e, acima de tudo, pode ter implicações clínicas importantes para as duas doenças. Descritores: Esquizofrenia, transtorno bipolar, metabolismo, metabolismo cerebral, estresse, alostase.

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Early intervention for bipolar disorder: current imperatives, future directions

Cited by 17 publications

References 82 publications

Manic Symptoms in Youth: Dimensions, Latent Classes, and Associations With Parental Psychopathology

Manic Symptoms in Youth: Dimensions, Latent Classes, and Associations With Parental Psychopathology

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

The "selfish brain" hypothesis for metabolic abnormalities in bipolar disorder and schizophrenia

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