Personalized management of bipolar disorder

Bipolar disorder (BD) is one of the most serious psychiatric disorders. The rates of disability, the risk of suicide attempts and their high lethality, as well as frequent and severe psychiatric and medical comorbidities, put it among the major causes of mortality and disability worldwide. At the same time, many patients can do well when treated properly. In this review, we focus on those aspects of the clinical care that offer the potential of individualized approach, in the context of the recent technology driven advances in the comprehension of the neurobiological underpinnings of BD. We first review those clinical and biological factors that can help identifying individuals at high risk of developing BD. Among these are a family history of BD and/or completed suicide, prodromal symptoms (in childhood and/or adolescence) such as anxiety and mood lability, early onset, and poor response to antidepressants. Panels of genetic markers are also being studied to identify subjects at risk for BD. Further, neuroimaging studies have found an increased gray matter density in the right Inferior Frontal Gyrus (rIFG) as a possible risk marker of BD. We then examine clinical factors that influence the initiation, selection and possibly discontinuation of long-term treatment. Lastly, we discuss the risk of side effects in BD, and their relevance for treatment adherence and for treatment monitoring. In summary, we discuss how a personalized approach in BD can be implemented through the identification of specific clinical and molecular predictors. We show that the realization of a personalized management of BD is not only of a theoretical value, but has substantial clinical repercussions, resulting in a significant reduction of the long-term morbidity and mortality associated to BD.