Is “early intervention” in bipolar disorder what it claims to be?
Corresponding Author
Gin S Malhi
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
Correspondence
Gin S Malhi, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Email: [email protected]
Search for more papers by this authorGrace Morris
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
Search for more papers by this authorAmber Hamilton
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
Search for more papers by this authorTim Outhred
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
Search for more papers by this authorZola Mannie
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
Search for more papers by this authorCorresponding Author
Gin S Malhi
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
Correspondence
Gin S Malhi, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Email: [email protected]
Search for more papers by this authorGrace Morris
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
Search for more papers by this authorAmber Hamilton
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
Search for more papers by this authorTim Outhred
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
Search for more papers by this authorZola Mannie
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, , Australia
CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW,, Australia
Search for more papers by this authorAbstract
Background
The notion of early intervention is understandably appealing for conditions such as bipolar disorder (BD), a chronic life-long illness that increases risk of suicide and diminishes quality of life. It is purported that intervening early in the course of the illness with suitable interventions could substantially alter the trajectory of BD and improve outcomes. However, while there are obvious benefits to the prompt commencement of treatment, it is important to consider the gaps in our understanding regarding the aetiopathogenesis of bipolar disorder—upon which the paradigm of early intervention is predicated.
Methods
A literature search was undertaken using recognized search engines: PubMed, PsycINFO Medline, and Scopus, along with auxiliary manual searches.
Results
This review first examines how the unpredictable nature of BD creates substantial difficulties when determining an optimal therapeutic target for early intervention. Second, the challenges with identifying appropriate populations and apposite times for early intervention strategies is discussed. Finally, the risks associated with intervening early are examined, highlighting the potential harmful effects of initiating medication.
Conclusion
Early intervention for BD is a potentially useful strategy that warrants investigation, but until the emergence and trajectory of the illness are definitive, and a clear view of key targets is achieved, a more conservative approach to treating nascent BD and its antecedent symptoms is needed.
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