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Mania, a psychological condition characterized by elevated mood, increased energy, and reduced sleep need, is part of the bipolar disorder cycle. The exact cause of mania isn't entirely known, but it is thought to be a combination of genetic, environmental, and neurological factors. Bipolar disorder involves alternating manic and depressive episodes. Mood stabilizers like lithium, antipsychotics, and anticonvulsants help manage these episodes. Lithium carbonate is particularly effective as...
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[Early intervention in bipolar affective disorders: Why, when and how].

A Pouchon1, E Fakra2, F Haesebaert3

  • 1University Grenoble Alpes, 38000 Grenoble, France; Inserm, U1216, 38000 Grenoble, France; Adult Psychiatry Department, CHU Grenoble Alpes, 38000 Grenoble, France.

L'Encephale
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Summary

Early intervention for bipolar disorder (BD) is crucial. Identifying at-risk individuals and those in early stages can improve treatment outcomes and recovery chances.

Keywords:
Bipolar disorderEarly interventionFirst episodeHigh riskIntervention précocePremier épisodeStagingSujets à risquesTrouble bipolaire

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Area of Science:

  • Psychiatry and Mental Health
  • Neuroscience
  • Clinical Psychology

Background:

  • Bipolar disorder (BD) is a chronic, severe psychiatric illness with significant diagnostic delays and low remission rates.
  • Early onset in adolescence or early adulthood can impede socio-professional development.
  • The vulnerability-stress model and clinical staging model highlight the interaction of genetic and environmental factors.

Purpose of the Study:

  • To review current data on the features, screening, and early treatment of bipolar disorder.
  • To advocate for early intervention strategies for at-risk individuals and those experiencing their first episode of mania or hypomania.
  • To reduce the duration of untreated illness and enhance therapeutic response and recovery.

Main Methods:

  • A narrative literature review was conducted.
  • Data were gathered on early-stage features (risk factors, symptoms), screening methods (populations, tools), and early treatment approaches (settings, therapies).

Main Results:

  • Early stages are characterized by genetic and prenatal risk factors, distal (aspecific) and proximal (subsyndromic hypomanic) symptoms.
  • Targeted screening is recommended for high-risk groups (e.g., children of BD patients) using validated tools and ultra-high risk criteria.
  • Early intervention services (EIS) offer comprehensive evaluations; treatments include symptomatic pharmaceuticals, mood stabilizers, and non-pharmacological approaches like psychoeducation and psychotherapy.

Conclusions:

  • Early intervention services for psychosis should consider developing BD-specific screening and treatment programs.
  • Training frontline practitioners, utilizing biomarkers (imaging, inflammation proteins), and exploring neuroprotective agents (e.g., folic acid) show promise.
  • Further large-scale studies and long-term follow-up are needed to establish consensus on screening and treatment tools for early-stage BD.