Universität zu Köln

Berk, Michael ORCID: 0000-0002-5554-6946, Berk, Lesley ORCID: 0000-0002-3677-7503, Dodd, Seetal ORCID: 0000-0002-7918-4636, Cotton, Sue ORCID: 0000-0002-9386-8348, Macneil, Craig, Daglas, Rothanthi, Conus, Philippe, Bechdolf, Andreas, Moylan, Steven ORCID: 0000-0001-8901-6225 and Malhi, Gin S. (2014). Stage managing bipolar disorder. Bipolar Disord., 16 (5). S. 471 - 478. HOBOKEN: WILEY. ISSN 1399-5618

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Abstract

Objectives: Clinical staging is widespread in medicine - it informs prognosis, clinical course, and treatment, and assists individualized care. Staging places an individual on a probabilistic continuum of increasing potential disease severity, ranging from clinically at-risk or latency stage through first threshold episode of illness or recurrence, and, finally, to late or end-stage disease. The aim of the present paper was to examine and update the evidence regarding staging in bipolar disorder, and how this might inform targeted and individualized intervention approaches. Methods: We provide a narrative review of the relevant information. Results: In bipolar disorder, the validity of staging is informed by a range of findings that accompany illness progression, including neuroimaging data suggesting incremental volume loss, cognitive changes, and a declining likelihood of response to pharmacological and psychosocial treatments. Staging informs the adoption of a number of approaches, including the active promotion of both indicated prevention for at-risk individuals and early intervention strategies for newly diagnosed individuals, and the tailored implementation of treatments according to the stage of illness. Conclusions: The nature of bipolar disorder implies the presence of an active process of neuroprogression that is considered to be at least partly mediated by inflammation, oxidative stress, apoptosis, and changes in neurogenesis. It further supports the concept of neuroprotection, in that a diversity of agents have putative effects against these molecular targets. Clinically, staging suggests that the at-risk state or first episode is a period that requires particularly active and broad-based treatment, consistent with the hope that the temporal trajectory of the illness can be altered. Prompt treatment may be potentially neuroprotective and attenuate the neurostructural and neurocognitive changes that emerge with chronicity. Staging highlights the need for interventions at a service delivery level and implementing treatments at the earliest stage of illness possible.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Berk, Michael UNSPECIFIED orcid.org/0000-0002-5554-6946 UNSPECIFIED Berk, Lesley UNSPECIFIED orcid.org/0000-0002-3677-7503 UNSPECIFIED Dodd, Seetal UNSPECIFIED orcid.org/0000-0002-7918-4636 UNSPECIFIED Cotton, Sue UNSPECIFIED orcid.org/0000-0002-9386-8348 UNSPECIFIED Macneil, Craig UNSPECIFIED UNSPECIFIED UNSPECIFIED Daglas, Rothanthi UNSPECIFIED UNSPECIFIED UNSPECIFIED Conus, Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Bechdolf, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Moylan, Steven UNSPECIFIED orcid.org/0000-0001-8901-6225 UNSPECIFIED Malhi, Gin S. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-433160
DOI:	10.1111/bdi.12099
Journal or Publication Title:	Bipolar Disord.
Volume:	16
Number:	5
Page Range:	S. 471 - 478
Date:	2014
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	1399-5618
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EARLY INTERVENTION; RELAPSE PREVENTION; EUTHYMIC PATIENTS; ILLNESS; ADOLESCENTS; EVOLUTION; LITHIUM; NEUROPROGRESSION; SENSITIZATION; RECURRENCE Multiple languages Clinical Neurology; Neurosciences; Psychiatry Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/43316