دانلود رایگان مقاله انگلیسی مداخله زودهنگام در اختلال دوقطبی - NCBI 2017

Bipolar disorder is a recurrent disorder that affects more than 1% of the world population and usually has its onset during youth. Its chronic course is associated with high rates of morbidity and mortality, making bipolar disorder one of the main causes of disability among young and working-age people. The implementation of early intervention strategies may help to change the outcome of the illness and avert potentially irreversible harm to patients with bipolar disorder, as early phasesmay bemore responsive to treatment andmay need less aggressive therapies. Early intervention in bipolar disorder is gaining momentum. Current evidence emerging from longitudinal studies indicates that parental early-onset bipolar disorder is the most consistent risk factor for bipolar disorder. Longitudinal studies also indicate that a full-blown manic episode is often preceded by a variety of prodromal symptoms, particularly subsyndromal manic symptoms, therefore supporting the existence of an at-risk state in bipolar disorder that could be targeted through early intervention. There are also identifiable risk factors that influence the course of bipolar disorder, some of them potentially modifiable. Valid biomarkers or diagnosis tools to help clinicians identify individuals at high risk of conversion to bipolar disorder are still lacking, although there are some promising early results. Pending more solid evidence on the best treatment strategy in early phases of bipolar disorder, physicians should carefully weigh the risks and benefits of each intervention. Further studies will provide the evidence needed to finish shaping the concept of early intervention.

SUMMARY AND FUTURE DIRECTIONS

The findings of this review support the notion of a prodromal state and a progressive course in bipolar disorder. This dynamic course fits in the model of clinical staging proposed by several authors (14, 134–137), which assumes that illnesses progress from an at-risk stage to a late and resistant stage. A positive family history of bipolar disorder, particularly if the parents have early-onset bipolar disorder, is the most significant risk factor for developing a bipolar spectrum disorder. Regarding prodromal symptoms, the most robust result is that subthreshold (hypo)manic symptoms are the strongest predictor of bipolar conversion, both in studies focusing on bipolar offspring and in community youths. Consequently, this translates into a need for screening for attenuated mania-like symptoms when assessing young patients seeking help for mood lability, anxiety, depression, or 10 ajp.psychiatryonline.org ajp in Advance EARLY INTERVENTION IN BIPOLAR DISORDER behavioral disorders, especially among bipolar offspring (138). Moreover, preliminary findings indicate that bipolar offspring with an aberrant inflammatory state or changes in the volume or activity of the amygdala may be more vulnerable to developing a mood disorder, suggesting a potential role for these alterations as putative biomarkers for disease prediction in individuals at genetic risk (121, 139).