How to prevent the malignant progression of bipolar disorder
Braz. J. Psychiatry (São Paulo, 1999, Impr.)
;
42(5): 552-557, Sept.-Oct. 2020. graf
Article
in English
| LILACS
| ID: biblio-1132123
ABSTRACT
There is increasing recognition that, in a high percentage of cases, bipolar disorder is a progressive illness. Multiple types of sensitization (or increased reactivity to repetition of the same stimulus) drive illness progression. One of the clearest is that of episode sensitization, where increased numbers of prior episodes are associated with: faster recurrences; more dysfunction; disability; social, educational, and employment deficits; suicide; medical comorbidities; cognitive dysfunction; and an increased incidence of dementia in old age. Repetition of stressors and bouts of substance abuse can also result in sensitization. Each type of sensitization appears to have an epigenetic basis, such that preventing sensitization should minimize the accumulation of adverse epigenetic chemical marks on DNA, histones, and microRNA. New data emphasize the importance of early, consistent intervention after an initial manic episode. The cognitive dysfunction associated with a first episode improves only if there are no further episode recurrences during the next year. A randomized study has also shown that comprehensive multimodal prophylactic intervention for 2 years leads to improvements in illness course extending over a total of 6 years. Intensive treatment of the earliest stages of bipolar disorder can thus exert lasting positive effects on the course of illness.
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Bipolar Disorder
/
Substance-Related Disorders
Type of study:
Controlled clinical trial
/
Prognostic study
Limits:
Humans
Language:
English
Journal:
Braz. J. Psychiatry (São Paulo, 1999, Impr.)
Journal subject:
Psychiatry
Year:
2020
Type:
Article
Affiliation country:
United States
Institution/Affiliation country:
George Washington University/US
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