A systematic review of interventions in the early course of bipolar disorder I or II: a report of the International Society for Bipolar Disorders Taskforce on early intervention

International Journal of Bipolar Disorders

Review

G. Murray¹  E. Wong²  L. V. Kessing³  M. Hillegers⁴  M. Tohen⁵  L. N. Yatham⁶  T. Goldstein⁷  A. H. Young⁸  S. Jauhar⁸  M. Berk⁹  L. Berk⁹  S. Marwaha^1,10  D. Hett^1,10  J. Scott^1,11  M. A. Fristad^1,12  A. Ratheesh^1,13  D. J. Miklowitz^1,14  J. Ramain^1,15  P. Conus^1,15 

[1] Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia;Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia;Copenhagen Affective Disorder Research Center (CADIC), Psychiatric Center Copenhagen, Copenhagen, Denmark;Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark;Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre, Rotterdam, The Netherlands;Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, NM, USA;Department of Psychiatry, University of British Columbia, Vancouver, Canada;Department of Psychiatry, University of Pittsburgh, Pittsburgh, USA;Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK;South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, BR3 3BX, Kent, UK;IMPACT-The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia;Institute for Mental Health, University of Birmingham, Birmingham, UK;Birmingham and Solihull Mental Health NHS Trust, Birmingham, UK;Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK;Nationwide Children’s Hospital, The Ohio State University, Columbus, USA;Orygen, 35 Poplar Road, Parkville, VIC, Australia;Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia;Semel Institute for Neuroscience and Human Behavior, Los Angeles School of Medicine, University of California, Los Angeles, USA;TIPP Program, Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland;

关键词: Bipolar disorder;    Early intervention;    Course;    Lithium;    Mood stabilisers;    Antipsychotics;    CBT;    Psychoeducation;    Mania;    Depression;    Remission;    Recurrence;    Systematic review;   

DOI  :  10.1186/s40345-022-00275-3

 received in 2022-09-22, accepted in 2022-11-14,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundGiven the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II.MethodsWe completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the ‘early course’ of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach.ResultsFrom 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course.Conclusions and recommendationsWhile there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness course. Specifically, there is a compelling need to compare the relative benefits of lithium with other pharmacological agents in preventing recurrences. In addition to symptomatic outcomes, there should be a greater focus on functional impact and tolerability. Effective pharmacological and psychological interventions should be offered to those in early course of BD, balancing potential risks using shared decision-making approaches.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 1