Early intervention for bipolar disorder - Do current treatment guidelines provide recommendations for the early stages of the disorder?

TY - JOUR

T1 - Early intervention for bipolar disorder - Do current treatment guidelines provide recommendations for the early stages of the disorder?

AU - Chia, Ming Fang

AU - Cotton, Sue

AU - Filia, Kate

AU - Phelan, Mark

AU - Conus, Philippe

AU - Jauhar, Sameer

AU - Marwaha, Steven

AU - McGorry, Patrick D

AU - Davey, Christopher

AU - Berk, Michael

AU - Ratheesh, Aswin

PY - 2019/10/1

Y1 - 2019/10/1

N2 - 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.

AB - 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.

KW - Adolescents

KW - Bipolar disorder

KW - Depression

KW - Guidelines

KW - Mania

KW - Staging

UR - http://www.scopus.com/inward/record.url?scp=85069969583&partnerID=8YFLogxK

U2 - 10.1016/j.jad.2019.07.062

DO - 10.1016/j.jad.2019.07.062

M3 - Review article

C2 - 31377603

AN - SCOPUS:85069969583

SN - 0165-0327

VL - 257

SP - 669

EP - 677

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -