Hasler Gregor, Wolf Andreas
Department of Molecular Psychiatry, University Hospital of Psychiatry, University of Bern, Bolligenstrasse 111, 3000 Bern, Switzerland.
Department of Molecular Psychiatry, University Hospital of Psychiatry, University of Bern, Bolligenstrasse 111, 3000 Bern, Switzerland.
Eur Neuropsychopharmacol. 2015 Mar;25(3):283-94. doi: 10.1016/j.euroneuro.2014.12.006. Epub 2015 Jan 2.
In bipolar disorders, there are unclear diagnostic boundaries with unipolar depression and schizophrenia, inconsistency of treatment guidelines, relatively long trial-and-error phases of treatment optimization, and increasing use of complex combination therapies lacking empirical evidence. These suggest that the current definition of bipolar disorders based on clinical symptoms reflects a clinically and etiologically heterogeneous entity. Stratification of treatments for bipolar disorders based on biomarkers and improved clinical markers are greatly needed to increase the efficacy of currently available treatments and improve the chances of developing novel therapeutic approaches. This review provides a theoretical framework to identify biomarkers and summarizes the most promising markers for stratification regarding beneficial and adverse treatment effects. State and stage specifiers, neuropsychological tests, neuroimaging, and genetic and epigenetic biomarkers will be discussed with respect to their ability to predict the response to specific pharmacological and psychosocial psychotherapies for bipolar disorders. To date, the most reliable markers are derived from psychopathology and history-taking, while no biomarker has been found that reliably predicts individual treatment responses. This review underlines both the importance of clinical diagnostic skills and the need for biological research to identify markers that will allow the targeting of treatment specifically to sub-populations of bipolar patients who are more likely to benefit from a specific treatment and less likely to develop adverse reactions.
在双相情感障碍中，与单相抑郁症和精神分裂症的诊断界限不明确，治疗指南不一致，治疗优化的反复试验阶段相对较长，且越来越多地使用缺乏实证依据的复杂联合疗法。这些表明，目前基于临床症状对双相情感障碍的定义反映了一个临床和病因学上的异质性实体。迫切需要基于生物标志物和改进的临床标志物对双相情感障碍的治疗进行分层，以提高现有治疗的疗效，并增加开发新治疗方法的机会。本综述提供了一个识别生物标志物的理论框架，并总结了关于有益和不良治疗效果分层的最有前景的标志物。将讨论状态和阶段说明符、神经心理学测试、神经影像学以及遗传和表观遗传生物标志物预测双相情感障碍对特定药物和心理社会心理治疗反应的能力。迄今为止，最可靠的标志物来自精神病理学和病史采集，尚未发现能可靠预测个体治疗反应的生物标志物。本综述强调了临床诊断技能的重要性以及开展生物学研究以识别标志物的必要性，这些标志物将使治疗能够专门针对更可能从特定治疗中获益且更不易出现不良反应的双相情感障碍亚人群。
