Multifactorial approach needed for early bipolar detection

Oct 24 2013

By Sara Freeman, medwireNews Reporter

At-risk states for bipolar disorder require a multifaceted approach to be identified and appropriately treated, according to preliminary results from the Dresden High-Risk Project.

“[E]arly detection and intervention in patients with [bipolar disorder] provides an opportunity to improve outcomes,” the team behind the project writes in the Journal of Affective Disorders.

Karolina Leopold (Technische Universität Dresden, Germany) and colleagues add: “The identification and treatment of at-risk subjects could have a preventative effect, besides alleviation of acute symptoms and preservation or improvement of psychosocial functioning.”

The Dresden High-Risk Project aims to prospectively collate data on the symptomatology and subsequent treatment of individuals at risk for bipolar disorder. For the current analysis, Leopold and team used a standardized diagnostic procedure to assess the first 180 individuals seeking help at the early recognition center at their institution.

The mean age of the help-seeking individuals was 25 years. A total of 29 (16%) individuals who were screened met criteria for being at risk for bipolar disorder, 27 (93%) of whom had a current or lifetime mental illness other than bipolar disorder.

The most common form of other mental illness seen was major depressive disorder (MDD), affecting 79% of individuals; 41% had at least one other comorbidity, including anxiety disorder, substance abuse, attention deficit hyperactivity disorder (ADHD), and personality disorder.

The main risk factors identified for being at risk for bipolar disorder were a positive family history in over one-third of individuals, MDD in 41% and/or psychosis in 7%, subsyndromal main symptoms in 52%, and increasing mood swing in 62%.

Other, secondary risk factors included anxiety, fearfulness, or both, in 90% of cases; decreased psychosocial functioning in 79%; recent or lifetime affective disorder in 79%; specific sleep and circadian rhythm disturbances in 62%; increasing substance use over time in 17%; and lifetime or suspected ADHD.

Just under half of the at-risk patients had received some form of treatment in the past, which included drug therapy or psychotherapeutic approaches. The team offered psychoeducation to all patients, with psychotherapy and/or medication all offered if thought necessary.

“Altogether, 45% of patients with at-risk state were not in any clinical care prior to reaching our program due to underrecognition of the problems by themselves, family members and/or clinicians, or due to barriers to seek or access care,” Leopold and team write.

They conclude: “As most at-risk patients meet criteria for other mental disorders, the short- and long-term impact of different treatment strategies on symptomatic, functional and diagnostic outcomes requires detailed investigation.”

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