From the Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; the Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil; the Centre for Innovation in Mental and Physical Health and Clinical Treatment and Barwon Health, School of Medicine, Deakin University, Geelong, Australia; the Laboratory of Calcium Binding Proteins in the Central Nervous System, Department of Biochemistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; the Department of Psychiatry, University of Melbourne, Parkville, Australia; Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Australia; the Florey Institute for Neuroscience and Mental Health, Parkville, Australia; the Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh; the Department of Psychiatry and Behavioral Sciences, Health Sciences Center, University of New Mexico, Albuquerque; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, Calif.; and the VA Palo Alto Health Care System, Palo Alto, Calif.
Am J Psychiatry. 2018 May 1;175(5):411-426. doi: 10.1176/appi.ajp.2017.17090972. Epub 2018 Jan 24.
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 phases may be more responsive to treatment and may 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. AJP AT 175 Remembering Our Past As We Envision Our Future April 1925: Interpretations of Manic-Depressive Phases Earl Bond and G.E. Partridge reviewed a number of patients with manic-depressive illness in search of a unifying endo-psychic conflict. They concluded that understanding either phase of illness was "elusive" and "tantalizing beyond reach." (Am J Psychiatry 1925: 81: 643-662 ).
双相障碍是一种复发性疾病，影响着全球超过 1%的人口，通常在青年时期发病。其慢性病程与高发病率和死亡率相关，使双相障碍成为年轻和工作年龄人群残疾的主要原因之一。实施早期干预策略可能有助于改变疾病的结局，避免双相障碍患者可能出现的潜在不可逆转的伤害，因为早期阶段可能对治疗更有反应，并且可能需要较少的激进治疗。双相障碍的早期干预正在兴起。来自纵向研究的现有证据表明，父母早期发病的双相障碍是双相障碍最一致的风险因素。纵向研究还表明，全面躁狂发作通常之前会出现各种前驱症状，特别是亚综合征性躁狂症状，因此支持双相障碍存在一个处于风险状态，可以通过早期干预来靶向。还有一些可识别的风险因素会影响双相障碍的病程，其中一些是可以改变的。虽然有一些有希望的早期结果，但仍缺乏有助于临床医生识别有双相障碍转换高风险的个体的有效生物标志物或诊断工具。在双相障碍早期阶段的最佳治疗策略方面仍缺乏更确凿的证据，因此医生应仔细权衡每种干预措施的风险和益处。进一步的研究将提供完成塑造早期干预概念所需的证据。
