The clinical management of bipolar disorder complexity using a stratified model

Malhi, Gin S; Bargh, Danielle M; Cashman, Emma; Frye, Mark A.; Gitlin, Michael

doi:10.1111/j.1399-5618.2012.00993.x

Cited by 38 publications

(37 citation statements)

References 261 publications

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“…These have been shown to sustain health and prevent relapse, in conjunction with pharmacotherapy 7. Substance abuse is highly prevalent in this population and should be recognised as a potential trigger, alongside signs of a shift in mood and/or coping 46. Psychoeducation is therefore important for managing medication and promoting adherence, also managing the disease long term 45.…”

Section: Methodsmentioning

confidence: 99%

Maintaining mood stability in bipolar disorder: a clinical perspective on pharmacotherapy

Malhi

McAulay

Das

et al. 2014

Evid Based Mental Health

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Section: Methodsmentioning

confidence: 99%

Maintaining mood stability in bipolar disorder: a clinical perspective on pharmacotherapy

Malhi

McAulay

Das

et al. 2014

Evid Based Mental Health

Self Cite

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“…Serum BDNF levels were found to be decreased [91] or unchanged [92, 93] in BD-P and BD-FDR compared to healthy controls. Duffy et al reported that the BDNF genotype significantly moderates the association between high-risk status for both gene expression and protein levels in BD offspring [88].…”

Section: Resultsmentioning

confidence: 99%

Neurobiology of Risk for Bipolar Disorder

Özerdem

Ceylan

Can

2016

Curr Treat Options Psych

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Opinion statementBipolar disorder (BD) is a chronic mental illness which follows a relapsing and remitting course and requires lifetime treatment. The lack of biological markers for BD is a major difficulty in clinical practice. Exploring multiple endophenotypes to fit in multivariate genetic models for BD is an important element in the process of finding tools to facilitate early diagnosis, early intervention, prevention of new episodes, and follow-up of treatment response in BD. Reviewing of studies on neuroimaging, neurocognition, and biochemical parameters in populations with high genetic risk for the illness can yield an integrative perspective on the neurobiology of risk for BD. The most up-to-date data reveals consistent deficits in executive function, response inhibition, verbal memory/learning, verbal fluency, and processing speed in risk groups for BD. Functional magnetic resonance imaging (fMRI) studies report alterations in the activity of the inferior frontal gyrus, medial prefrontal cortex, and limbic areas, particularly in the amygdala in unaffected first-degree relatives (FDR) of BD compared to healthy controls. Risk groups for BD also present altered immune and neurochemical modulation. Despite inconsistencies, accumulating data reveals cognitive and imaging markers for risk and to a less extent resilience of BD. Findings on neural modulation markers are preliminary and require further studies. Although the knowledge on the neurobiology of risk for BD has been inadequate to provide benefits for clinical practice, further studies on structural and functional changes in the brain, neurocognitive functioning, and neurochemical modulation have a potential to reveal biomarkers for risk and resilience for BD. Multimodal, multicenter, population-based studies with large sample size allowing for homogeneous subgroup analyses will immensely contribute to the elucidation of biological markers for risk for BD in an integrative model.

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“…In doing so, the differential cognitive and emotional inhibition and activation changes associated with the manic and depressed phases may be better integrated and understood. Further, longitudinal and simultaneous multimodal physiological assessment is likely to better differentiate phases of illness, characterize clinical trajectory, and provide insights into the chronobiological changes associated with phase and course in BSDs (see Malhi et al 2012;Malhi and Kuiper 2013).…”

Section: Discussionmentioning

confidence: 99%

“…Characterization of BSD as an embodied disturbance is gaining some attention with consideration of molecular biological correlates across circadian, homeostatic, and stress systems (see Malhi et al 2012;Malhi and Kuiper 2013). A previous review of BSDs (Green et al 2007) has discussed the potential impact of the neurological dysfunction on autonomic arousal systems; however, the exact disturbance remains to be determined.…”

Section: An Embodied Framework For the Psychophysiology Of Bipolar Spmentioning

confidence: 98%

“…In this context, physiological measures provide an important tool through which diagnosis could be improved and treatment options tailored. Currently, the assessment and management of bipolar spectrum disorders (BSDs) often entails misdiagnosis following a significant delay in detection (Hirschfeld et al 2003;Suppes et al 2001), the inability to predict course (Crowe et al 2012;Malhi et al 2012, trial and error in treatment selection Sachs 2013), and a failure to implement long-term management strategies (Keck 2006;Malhi et al 2009). Therefore, improvement in the assessment and treatment of those with BSDs is critical given the great personal (Bonnín et al 2012;Merikangas et al 2007) and socioeconomic burden associated with BSDs (Merikangas et al 2007).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Physiological Correlates of Bipolar Spectrum Disorders and their Treatment

Outhred

Kemp

Malhi

2014

Electrophysiology and Psychophysiology in Psychiatry and Psychopharmacology

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Bipolar spectrum disorders (BSDs) are associated with great personal and socioeconomic burden, with patients often facing a delay in detection, misdiagnosis when detected, and a trial-and-error approach to finding the most appropriate treatment. Therefore, improvement in the assessment and management of patients with BSDs is critical. Should valid physiological measures for BSDs be identified and implemented, significant clinical improvements are likely to be realized. This chapter reviews the physiological correlates of BSDs and treatment, and in doing so, examines the neuroimaging, electroencephalogram, and event-related potential, and peripheral physiological correlates that both characterize and differentiate BSDs and their response to treatment. Key correlates of BSDs involve underlying disturbances in prefrontal and limbic network neural activity, early neural processing, and within the autonomic nervous system. These changes appear to be mood-related and can be normalized with treatment. We adopt an "embodied" perspective and propose a novel, working framework that takes into account embodied psychophysiological mechanisms in which the physiological correlates of BSD are integrated. This approach may in time provide the objective physiological measures needed to improve assessment and decision making when treating patients with BSDs. Future research with integrative, multimodal measures is likely to yield potential applications for physiological measures of BSD that correlate closely with diagnosis and treatment.

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The clinical management of bipolar disorder complexity using a stratified model

Cited by 38 publications

References 261 publications

Maintaining mood stability in bipolar disorder: a clinical perspective on pharmacotherapy

Maintaining mood stability in bipolar disorder: a clinical perspective on pharmacotherapy

Neurobiology of Risk for Bipolar Disorder

Physiological Correlates of Bipolar Spectrum Disorders and their Treatment

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