Stage managing bipolar disorder.

Détails

Ressource 1Télécharger: BIB_EB56706F37E1.P001.pdf (428.15 [Ko])
Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_EB56706F37E1
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Stage managing bipolar disorder.
Périodique
Bipolar Disorders
Auteur(s)
Berk M., Berk L., Dodd S., Cotton S., Macneil C., Daglas R., Conus P., Bechdolf A., Moylan S., Malhi G.S.
ISSN
1399-5618 (Electronic)
ISSN-L
1398-5647
Statut éditorial
Publié
Date de publication
2014
Peer-reviewed
Oui
Volume
16
Numéro
5
Pages
471-477
Langue
anglais
Notes
Publication types: Journal Article Publication Status: ppublish Document Type: Review
Résumé
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.
Pubmed
Web of science
Open Access
Oui
Création de la notice
19/09/2014 18:05
Dernière modification de la notice
20/08/2019 17:13
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