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

Rios, Adiel C.; Noto, Mariane Nunes; Rizzo, Lucas B.; Mansur, Rodrigo B.; Martins, Flávio E.; Grassi‐Oliveira, Rodrigo; Correll, Christoph U.; Brietzke, Elisa

doi:10.1590/1516-4446-2014-1620

Cited by 19 publications

(16 citation statements)

References 54 publications

(85 reference statements)

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“…28,29 Several studies have recognized mood lability, major depressive episodes, subsyndromal manic symptoms, a diagnosis of a bipolar spectrum disorder (such as cyclothymia or BD not otherwise specified), and mood-congruent psychotic symptoms as precursors of BD. [30][31][32] On the other hand, in clinical practice, identification of a symptomatic high-risk BD phase is complicated by the complex nature of dimensions of this disorder, by potentially different symptom presentations in children and adolescents, 5,21,33 and by the blurred lines between the prodrome and the disease itself. 34 Retrospective and prospective studies have revealed a pattern of putative prodromal symptoms, of which mood lability/mood swings/cyclothymic features, depressive mood, racing thoughts, irritability, and physical agitation are most commonly reported.…”

Section: Clinical Presentation Of Early Stagesmentioning

confidence: 99%

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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Section: Clinical Presentation Of Early Stagesmentioning

confidence: 99%

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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“…The mean age of onset for BD is between 20 and 30 years, and risk of onset decreases with age thereafter (1,2). The long interval between early symptoms, correct diagnosis, and adequate treatment (5.8-6.7 years) (5,6) is associated with a worsened clinical course and a substantial burden of illness (7,8).…”

Section: Introductionmentioning

confidence: 99%

Risk Stratification for Bipolar Disorder Using Polygenic Risk Scores Among Young High-Risk Adults

et al. 2020

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Identifying high-risk groups with an increased genetic liability for bipolar disorder (BD) will provide insights into the etiology of BD and contribute to early detection of BD. We used the BD polygenic risk score (PRS) derived from BD genome-wide association studies (GWAS) to explore how such genetic risk manifests in young, high-risk adults. We postulated that BD-PRS would be associated with risk factors for BD. Methods: A final sample of 185 young, high-risk German adults (aged 18-35 years) were grouped into three risk groups and compared to a healthy control group (n = 1,100). The risk groups comprised 117 cases with attention deficit hyperactivity disorder (ADHD), 45 with major depressive disorder (MDD), and 23 help-seeking adults with early recognition symptoms [ER: positive family history for BD, (sub)threshold affective symptomatology and/or mood swings, sleeping disorder]. BD-PRS was computed for each participant. Logistic regression models (controlling for sex, age, and the first five ancestry principal components) were used to assess associations of BD-PRS and the high-risk phenotypes. Results: We observed an association between BD-PRS and combined risk group status (OR = 1.48, p < 0.001), ADHD diagnosis (OR = 1.32, p = 0.009), MDD diagnosis (OR = 1.96, p < 0.001), and ER group status (OR = 1.7, p = 0.025; not significant after correction for multiple testing) compared to healthy controls. Biere et al. Risk Stratification for Bipolar Disorder Conclusions: In the present study, increased genetic risk for BD was a significant predictor for MDD and ADHD status, but not for ER. These findings support an underlying shared risk for both MDD and BD as well as ADHD and BD. Improving our understanding of the underlying genetic architecture of these phenotypes may aid in early identification and risk stratification.

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“…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 .…”

Section: Introductionmentioning

confidence: 99%