Is there a role for early intervention in bipolar disorders?

Bipolar disorder is one of the most common causes of persistent disability in young people. This may be related to the early onset of the disorder and a highly recurrent course, which can affect the developmental trajectories of affected young people.

The impact of bipolar disorder can be limited by early identification and appropriate interventions, particularly in adolescents and young adults where the illness often first occurs. Long delays in the first diagnosis, concerns about neuroprogression and the development of staging models have created a strong need for early intervention in bipolar and related disorders. Early intervention typically refers to interventions from the first manic episode in bipolar type I. In bipolar type II, early interventions may target those with at least moderate to severe depressive episodes and past episodes of hypomania (Stage 2 disorder). Interventions prior to these stages may be considered to be preventive interventions or pre-onset interventions. This conceptual distinction is necessary as the type and focus of interventions differ in the pre- and post-onset stages.

For young people who have had an ‘onset’ of the disorder, there needs to be a strong focus on overall recovery and functioning, rather than a narrow focus on preventing remission or relapse. Hence, key elements of early intervention packages should include recovery focused psychological interventions, psychoeducation as well as vocational interventions, especially given the evidence that these interventions may be more effective in earlier illness stages. Furthermore, the appropriate use of medications may help prevent relapses, potentially aiding young people to better manage their illness. Collaborative and shared decision-making approaches, using medications with less potential for negative side effects, are essential and have the potential to help encourage young people during the recovery process.

Further research into understanding the trajectories of outcomes from early stages, discovering novel and targeted interventions, as well as determining other recovery strategies are important to address the unmet needs for young people with bipolar disorders. Reorienting existing services and developing new early intervention service systems will help deliver evidence-based intervention strategies for these young people.

If you are interested to hear more about working with young people early in the course of bipolar disorder, Aswin will be presenting at IEPA11 in a special symposium chaired by Dr. Craig MacNeil, along with other leaders in the field, including Professor Phillipe Conus and Professor Sue Cotton.

About the Authors:

Dr. Aswin Ratheesh is a consultant psychiatrist and an early career researcher at Orygen, the National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, University of Melbourne. He provides clinical care for young people with severe and emerging mental disorders across primary and tertiary youth mental health settings. His research interests include prospective prediction of bipolar disorder onset; determining better access and care pathways for those with established bipolar disorder and the development of new therapies for people with bipolar disorder. He has received research grant support from the Australian National Health and Medical Research Council and the Society for Mental Health Research, Australia.

You can find out more from Aswin here: ‪@_ratheeshaswin

Professor Michael Berk is Alfred Deakin Chair of Psychiatry at Deakin University and Barwon Health, where he heads the IMPACT Strategic Research Centre. He is a Honorary Professorial Research fellow in the Department of Psychiatry, the Florey Institute for Neuroscience and Mental Health, the School of Public Health and Preventive Medicine at Monash University and is a Professorial Fellow at Orygen. Michael is past president of the International Society for Bipolar disorders and the Australasian Society for Bipolar and Depressive Disorders. He has published over 800 papers predominantly on mood disorders.

References for further reading:

• Gore FM, Bloem PJ, Patton GC, Ferguson J, Joseph V, Coffey C, et al. Global burden of disease in young people aged 10-24 years: a systematic analysis. Lancet. 2011;377(9783):2093-102.
• Berk M, Malhi GS, Hallam K, Gama CS, Dodd S, Andreazza AC, et al. Early intervention in bipolar disorders: clinical, biochemical and neuroimaging imperatives. Journal of affective disorders. 2009;114(1-3):1-13.
• Macneil CA, Hasty M, Cotton S, Berk M, Hallam K, Kader L, et al. Can a targeted psychological intervention be effective for young people following a first manic episode? Results from an 18-month pilot study. Early Interv Psychiatry. 2012;6(4):380-8.
• Scott J, Paykel E, Morriss R, Bentall R, Kinderman P, Johnson T, et al. Cognitive-behavioural therapy for bipolar disorder. The British journal of psychiatry : the journal of mental science. 2006;188:488-9.

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