An evidence map of psychosocial interventions for the earliest stages of bipolar disorder

Abstract

Depression, schizophrenia, and bipolar disorder are three of the four most burdensome problems in people aged under 25 years. In psychosis and depression, psychological interventions are effective, low-risk, and high-benefit approaches for patients at high risk of first-episode or early-onset disorders. We review the use of psychological interventions for early-stage bipolar disorder in patients aged 15–25 years. Because previous systematic reviews had struggled to identify information about this emerging sphere of research, we used evidence mapping to help us identify the extent, distribution, and methodological quality of evidence because the gold standard approaches were only slightly informative or appropriate. This strategy identified 29 studies in three target groups: ten studies in populations at high risk for bipolar disorder, five studies in patients with a first episode, and 14 studies in patients with early-onset bipolar disorder. Of the 20 completed studies, eight studies were randomised trials, but only two had sample sizes of more than 100 individuals. The main interventions used were family, cognitive behavioural, and interpersonal therapies. Only behavioural family therapies were tested across all of our three target groups. Although the available interventions were well adapted to the level of maturity and social environment of young people, few interventions target specific developmental psychological or physiological processes (eg, ruminative response style or delayed sleep phase), or offer detailed strategies for the management of substance use or physical health.

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

“…Although pharmacotherapy is the treatment of choice for serious mental illness, there are clinical recommendations that suggest, especially at the first onset of symptoms, that psychotherapy can be very effective 40,41 . Our data suggest this is an opportunity for improving services for these patients.…”

Bipolar At-Risk Criteria: An Examination of Which Clinical Features Have Optimal Utility for Identifying Youth at Risk of Early Transition From Depression to Bipolar Disorders

“…Second, we suggest that it would be feasible and justifiable to monitor depressed youth at risk of ET-BD for this time period to offer the prospect of early interventions as appropriate 40 .…”

“…This would seem to indicate that it may be possible to develop a combined tool that could not only further our understanding not only of who is at risk of ET-BD, but also identify if any characteristics are unique to a 'mood disorder trajectory' and which may be shared with individuals who make a transition to psychosis. Clinically, this may help to plan generic as well as specific interventions and treatments 40 . It would also provide opportunities for research into underlying pathophysiological mechanisms associated with transition 6,35,37 .…”

Children in the US are at High Risk for Psychiatric Disorders: Early Monitoring by Parents May Enhance Awareness and Treatment

“…Not only were there markedly fewer relapses initially over the first 2 years in the specialty clinic group, but these differences persisted and were magnified over the subsequent 4 years even though all patients had returned to TAU after 2 years. These data together with a large number of controlled studies showing superior effects of randomized psychotherapy/psycho-education compared to TAU in children and adults with bipolar disorder [32][33][34], provide strong evidence for the benefits of multi-modal psychotherapeutic and pharmacological treatment.…”