Intervening early in bipolar disorder in young people: a review of the clinical staging model

2015 ◽  
Vol 32 (1) ◽  
pp. 31-43
Author(s):  
P. Power
Keyword(s):  
Bipolar Disorder ◽  
Early Intervention ◽  
Young People ◽  
Psychotic Disorders ◽  
Early Adulthood ◽  
General Medicine ◽  
Developmental Trajectory ◽  
Clinical Staging ◽  
Co Morbidity ◽  
Staging Model

Bipolar disorder (BPD) essentially has its onset during adolescence and early adulthood. It has the capacity to be highly disruptive, dislocating individuals from their normal developmental trajectory and potentially causing significant long-term co-morbidity and chronicity. At a societal level the burden created is greater than schizophrenia. This is not helped by the very substantial delays in its diagnosis and appropriate treatment. Thus, there is a clear rationale for intervening earlier and at a younger age. However, the field of early intervention in BPD is in its infancy. One approach that conceptually provides a basis for early intervention is the Clinical Staging Model (used widely in general medicine). This article outlines how this model helps in an understanding of the emerging stages of BPD. It also summarises the interventions that might be appropriately introduced if a person progresses from an early to a late stage of the illness. Early intervention has a well-established record in psychotic disorders. If it can be realised for BPDs, then it may hold out hope of better outcomes for the next generation of young people at risk.

scholarly journals The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models

2016 ◽  
Vol 46 (12) ◽  
pp. 2467-2484 ◽  
Author(s):  
A. B. Grierson ◽  
I. B. Hickie ◽  
S. L. Naismith ◽  
J. Scott
Keyword(s):  
Mental Disorders ◽  
Emotional Regulation ◽  
Potential Role ◽  
Psychotic Disorders ◽  
Developmental Trajectory ◽  
Clinical Staging ◽  
Neurocognitive Deficits ◽  
Illness Onset ◽  
Co Morbidity

Research in developmental psychopathology and clinical staging models has increasingly sought to identify trans-diagnostic biomarkers or neurocognitive deficits that may play a role in the onset and trajectory of mental disorders and could represent modifiable treatment targets. Less attention has been directed at the potential role of cognitive-emotional regulation processes such as ruminative response style. Maladaptive rumination (toxic brooding) is a known mediator of the association between gender and internalizing disorders in adolescents and is increased in individuals with a history of early adversity. Furthermore, rumination shows moderate levels of genetic heritability and is linked to abnormalities in neural networks associated with emotional regulation and executive functioning. This review explores the potential role of rumination in exacerbating the symptoms of alcohol and substance misuse, and bipolar and psychotic disorders during the peak age range for illness onset. Evidence shows that rumination not only amplifies levels of distress and suicidal ideation, but also extends physiological responses to stress, which may partly explain the high prevalence of physical and mental co-morbidity in youth presenting to mental health services. In summary, the normative developmental trajectory of rumination and its role in the evolution of mental disorders and physical illness demonstrates that rumination presents a detectable, modifiable trans-diagnostic risk factor in youth.

scholarly journals A neurodevelopment and neuroplasticity-based framework for early intervention in psychotic disorders

2017 ◽  
Vol 48 (3) ◽  
pp. 353-361 ◽  
Author(s):  
E. Bora
Keyword(s):  
Early Intervention ◽  
Psychotic Disorders ◽  
Sampling Bias ◽  
Clinical Staging ◽  
Cross Sectional ◽  
Research Programmes ◽  
Psychological Comorbidities ◽  
Staging Model ◽  
Progressive Disorder ◽  
Developmental Pathology

In recent years there has been growing interest in early intervention in psychotic disorders and a number of clinical and research programmes have been developed. The clinical staging model has been an essential part of early intervention as it provides the rationale of existing programmes. In medicine, clinical staging is a valuable approach in disorders where primary pathology is progressive in nature. However, the clinical staging model of psychosis has been proposed without establishing first that schizophrenia is a primarily progressive disorder. In reviewing existing evidence, this current paper argues that cross-sectional data interpreted as supportive of clinical staging data does not consider the effects of sampling bias, problems in reliability in assessing ‘soft symptoms’, or false positives. Longitudinal neurobiological studies do not provide a convincing case for primarily progressive pathology in schizophrenia. Clinical progression in schizophrenia can be better conceptualised as neuroplastic changes in response to interaction between core developmental pathology and environmental stimuli. An alternative rationale for early and continuous intervention targeting neurodevelopmental abnormality and neuroplastic changes, as well as medical and psychological comorbidities, is proposed in this paper.

Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles

2011 ◽  
Vol 21 (1) ◽  
pp. 47-57 ◽  
Author(s):  
G. de Girolamo ◽  
J. Dagani ◽  
R. Purcell ◽  
A. Cocchi ◽  
P. D. McGorry
Keyword(s):  
Early Intervention ◽  
Mental Disorders ◽  
Transition To Adulthood ◽  
Psychotic Disorders ◽  
Age Of Onset ◽  
Early Stage ◽  
Early Adulthood ◽  
Special Focus ◽  
Long Term Effects ◽  
Health Services Needs

Purpose of review.In this review, we provide an update of recent studies on the age of onset (AOO) of the major mental disorders, with a special focus on the availability and use of services providing prevention and early intervention.Recent findings.The studies reviewed here confirm previous reports on the AOO of the major mental disorders. Although the behaviour disorders and specific anxiety disorders emerge during childhood, most of the high-prevalence disorders (mood, anxiety and substance use) emerge during adolescence and early adulthood, as do the psychotic disorders. Early AOO has been shown to be associated with a longer duration of untreated illness, and poorer clinical and functional outcomes.Summary.Although the onset of most mental disorders usually occurs during the first three decades of life, effective treatment is typically not initiated until a number of years later. There is increasing evidence that intervention during the early stages of disorder may help reduce the severity and/or the persistence of the initial or primary disorder, and prevent secondary disorders. However, additional research is needed on effective interventions in early-stage cases, as well as on the long-term effects of early intervention, and for an appropriate service design for those with emerging mental disorders. This will mean not only the strengthening and re-engineering of existing systems, but is also crucial the construction of new streams of care for young people in transition to adulthood.

Clinical staging model in bipolar disorder: A few considerations

2019 ◽  
Vol 21 (3) ◽  
pp. 278-279
Author(s):  
Siddharth Sarkar ◽  
Nishtha Chawla
Keyword(s):  
Bipolar Disorder ◽  
Clinical Staging ◽  
Staging Model

Clinical Staging of Psychotic Disorders: From Dimensions to Neurobiology

2017 ◽  
Vol 41 (S1) ◽  
pp. S35-S35
Author(s):  
A. Batalla
Keyword(s):  
Psychotic Disorders ◽  
Clinical Staging ◽  
Treatment And Prevention ◽  
Ultra High Risk ◽  
Specific Subgroup ◽  
Competing Interest ◽  
Staging Model ◽  
New Biomarkers ◽  
Extent Of Disease ◽  
At Risk Mental State

The clinical staging model is an approach used in medicine to define the extent of disease. In psychiatry, this model has recently been applied to psychotic disorders to distinguish the earlier, non-specific features of illness (e.g. ultra-high risk [UHR]; at-risk mental state [ARMS]), from later, more severe features associated with chronic illness. A key element of the staging model is to identify and classify the neurobiological processes underlying the disorder and to define potential interventions in the different stages. With the premise that dysfunctional neural mechanisms underlie symptomatology, the integration of categorical phenotypic classifications (class of disorder) with dimensional criteria (domains of dysfunction) becomes crucial. This approach aims to better classify trans-diagnostic dimensions of disease and discrete symptom-specific subgroup populations within biological frameworks, which may lead to the detection of new biomarkers and the development of more effective treatment and prevention strategies.Disclosure of interestThe author has not supplied his declaration of competing interest.

Spanish Consensus on Physical Health in Patients with Bipolar Disorder

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
J. Saiz-Ruiz ◽  
J. Bobes ◽  
E. Vieta ◽  
J. Mostaza
Keyword(s):  
Bipolar Disorder ◽  
General Population ◽  
Physical Health ◽  
Psychosocial Functioning ◽  
General Medicine ◽  
Diagnostic Procedures ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Increased Risk ◽  
Co Morbidity

Background and objective:Bipolar disorder is a serious mental illness which may affect between 2% and 5% of the population. These patients present much higher morbidity and mortality rates than the general population. In addition to a higher mortality rate from suicide, they also have a higher prevalence of other physical disorders.The purpose of this consensus is to establish recommendations for diagnostic procedures and clinical interventions in order to control the risk factors which have repercussions on the physical health of the patients.Methods:After carrying out a systematic review of medical co-morbidity and mortality rates in bipolar disorder, two multidisciplinary consensus meetings were held in which 31 psychiatrists and 11 experts from other medical specialities participated.Working groups were formed for each speciality for the purposes of adapting the guidelines applied in the general population to these patients.Results:The bibliographical review revealed an increased risk of hypertension, obesity, smoking, pulmonary diseases, migraine and HIV infection. There is evidence of higher mortality rates from cardiovascular and respiratory diseases and infections, as well as from suicide. The expert group reached consensus on a series of basic measures for detecting medical co-morbidity. The resulting recommendations will be validated by Spanish Psychiatry and General Medicine Associations.Conclusion:The physical health of patients with bipolar disorder could be improved. It is hoped that the publication of this consensus will have an impact in terms of better psychosocial functioning, quality of life and life expectancy for these patients in Spain.

scholarly journals The developmental trajectory of bipolar disorder

2014 ◽  
Vol 204 (2) ◽  
pp. 122-128 ◽  
Author(s):  
Anne Duffy ◽  
Julie Horrocks ◽  
Sarah Doucette ◽  
Charles Keown-Stoneman ◽  
Shannon McCloskey ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
High Risk ◽  
Psychotic Disorders ◽  
Familial Risk ◽  
Childhood Anxiety ◽  
Developmental Trajectory ◽  
Developmental Approach ◽  
Increased Risk ◽  
Clinical Stages

BackgroundBipolar disorder is highly heritable and therefore longitudinal observation of children of affected parents is important to mapping the early natural history.AimsTo model the developmental trajectory of bipolar disorder based on the latest findings from an ongoing prospective study of the offspring of parents with well-characterised bipolar disorder.MethodA total of 229 offspring from families in which 1 parent had confirmed bipolar disorder and 86 control offspring were prospectively studied for up to 16 years. High-risk offspring were divided into subgroups based on the parental long-term response to lithium. Offspring were clinically assessed and DSM-IV diagnoses determined on masked consensus review using best estimate procedure. Adjusted survival analysis and generalised estimating equations were used to calculate differences in lifetime psychopathology. Multistate models were used to examine the progression through proposed clinical stages.ResultsHigh-risk offspring had an increased lifetime risk of a broad spectrum of disorders including bipolar disorder (hazard ratio (HR) = 20.89; P = 0.04), major depressive disorder (HR = 17.16; P = 0.004), anxiety (HR = 2.20; P = 0.03), sleep (HR = 28.21; P = 0.02) and substance use disorders (HR = 2.60; P = 0.05) compared with controls. However, only offspring from lithium non-responsive parents developed psychotic disorders. Childhood anxiety disorder predicted an increased risk of major mood disorder and evidence supported a progressive transition through clinical stages, from non-specific psychopathology to depressive and then manic or psychotic episodes.ConclusionsFindings underscore the importance of a developmental approach in conjunction with an appreciation of familial risk to facilitate earlier accurate diagnosis in symptomatic youth.

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