TY - JOUR
T1 - The case for improved care and provision of treatment for people with first-episode mania
AU - Jauhar, Sameer
AU - Ratheesh, Aswin
AU - Davey, Christopher
AU - Yatham, Lakshmi N
AU - McGorry, Patrick D
AU - McGuire, Phillip
AU - Berk, Michael
AU - Young, Allan H
N1 - Copyright © 2019 Elsevier Ltd. All rights reserved.
PY - 2019/10
Y1 - 2019/10
N2 - The care of people with first-episode mania has been overlooked in comparison with the care of patients with other non-affective psychoses, despite evidence suggesting targeted treatments might be of benefit for this patient group. In this Personal View, we outline the general epidemiology of first-episode mania in the context of bipolar disorder, the natural history of mania (with an emphasis on its recurrent nature), current evidence for pharmacological, psychological, and service-level interventions, current guidelines for the treatment of first-episode mania, and provide a patient's point of view of the care pathway (appendix). We note the paucity of high-quality evidence for interventions in first-episode mania and the lack of agreement among treatment guidelines in relation to treatment, especially maintenance treatment. We suggest that, based on high morbidity and clinical need, research evidence to inform guideline development is necessary, and in the interim, clearer guidance on treatment and diagnosis should be given; specifically, we have suggested that patients should be cared for within a first-episode psychosis service, when such a service exists.
AB - The care of people with first-episode mania has been overlooked in comparison with the care of patients with other non-affective psychoses, despite evidence suggesting targeted treatments might be of benefit for this patient group. In this Personal View, we outline the general epidemiology of first-episode mania in the context of bipolar disorder, the natural history of mania (with an emphasis on its recurrent nature), current evidence for pharmacological, psychological, and service-level interventions, current guidelines for the treatment of first-episode mania, and provide a patient's point of view of the care pathway (appendix). We note the paucity of high-quality evidence for interventions in first-episode mania and the lack of agreement among treatment guidelines in relation to treatment, especially maintenance treatment. We suggest that, based on high morbidity and clinical need, research evidence to inform guideline development is necessary, and in the interim, clearer guidance on treatment and diagnosis should be given; specifically, we have suggested that patients should be cared for within a first-episode psychosis service, when such a service exists.
KW - Bipolar Disorder/therapy
KW - Guidelines as Topic
KW - Humans
KW - Quality Improvement
U2 - 10.1016/S2215-0366(19)30082-3
DO - 10.1016/S2215-0366(19)30082-3
M3 - Review article
C2 - 31248840
SN - 2215-0366
VL - 6
SP - 869
EP - 876
JO - The lancet. Psychiatry
JF - The lancet. Psychiatry
IS - 10
ER -