Early intervention for bipolar disorder - Do current treatment guidelines provide recommendations for the early stages of the disorder?
- Chia MF Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Melbourne Medical School, University of Melbourne, Parkville, Australia.
- Cotton S Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.
- Filia K Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.
- Phelan M Orygen Youth Health, Parkville, Australia.
- Conus P Lausanne University and Hospital (CHUV), Lausanne, Switzerland.
- Jauhar S Department of Psychosis Studies, Institute of Psychiatry, King's College, London, UK.
- Marwaha S Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK.
- McGorry PD Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.
- Davey C Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Orygen Youth Health, Parkville, Australia.
- Berk M Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Deakin University IMPACT Strategic Research Centre, Geelong, Australia; Florey Institute of Neuroscience and Mental Health, Parkville, Australia.
- Ratheesh A Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia; Orygen Youth Health, Parkville, Australia. Electronic address: aswin.ratheesh@orygen.org.au.
- 2019-08-05
Published in:
- Journal of affective disorders. - 2019
Adolescents
Bipolar disorder
Depression
Guidelines
Mania
Staging
Adolescent
Adult
Antipsychotic Agents
Bipolar Disorder
Early Medical Intervention
Female
Humans
Male
Practice Guidelines as Topic
Young Adult
English
BACKGROUND
Interventions early in the course of bipolar disorder (BD) may have the potential to limit its functional and symptomatic impact. However, the implementation of specific early interventions for BD has been limited which may at least partly be due to the lack of guidelines focused on the early illness stages. We therefore aimed to review the current recommendations for early stage BD from clinical practice guidelines.
METHODS
We searched PubMED and PsychINFO for clinical guidelines for BD published in the ten years prior to 1 November 2018. Recommendations from identified guidelines that addressed early stage BD or first episode mania were consolidated and compared. We also reviewed the guidelines relating to adolescents with BD to complement the guidelines related to those in the early illness course.
RESULTS
We identified fourteen international and national guidelines on BD or affective psychoses. Most guidelines contained a separate section on adolescents, but only a few referred specifically to early stage BD. There were no consistent recommendations for early stage disorder, except with respect to the indications for maintenance medication treatments. For adolescents, there was a consistent recommendation for the use of second generation antipsychotics for treating acute mania.
LIMITATION
The main limitation is that the identified guidelines did not include primary data that clearly separated illness and developmental stages.
CONCLUSIONS
There is a lack of emphasis on early BD among widely-respected current clinical guidelines, likely reflecting the dearth of primary data. Future evidence or consensus-based recommendations could significantly inform clinical practice for this population.
Interventions early in the course of bipolar disorder (BD) may have the potential to limit its functional and symptomatic impact. However, the implementation of specific early interventions for BD has been limited which may at least partly be due to the lack of guidelines focused on the early illness stages. We therefore aimed to review the current recommendations for early stage BD from clinical practice guidelines.
METHODS
We searched PubMED and PsychINFO for clinical guidelines for BD published in the ten years prior to 1 November 2018. Recommendations from identified guidelines that addressed early stage BD or first episode mania were consolidated and compared. We also reviewed the guidelines relating to adolescents with BD to complement the guidelines related to those in the early illness course.
RESULTS
We identified fourteen international and national guidelines on BD or affective psychoses. Most guidelines contained a separate section on adolescents, but only a few referred specifically to early stage BD. There were no consistent recommendations for early stage disorder, except with respect to the indications for maintenance medication treatments. For adolescents, there was a consistent recommendation for the use of second generation antipsychotics for treating acute mania.
LIMITATION
The main limitation is that the identified guidelines did not include primary data that clearly separated illness and developmental stages.
CONCLUSIONS
There is a lack of emphasis on early BD among widely-respected current clinical guidelines, likely reflecting the dearth of primary data. Future evidence or consensus-based recommendations could significantly inform clinical practice for this population.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.jad.2019.07.062
- PMID 31377603
- Persistent URL
- https://sonar.ch/global/documents/278150
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