Setting the stage: from prodrome to treatment resistance in bipolar disorder

Authors


  • MB has received grant funding or research support from Beyond Blue, Bristol-Myers Squibb, Eli Lilly & Co., the Geelong Medical Research Foundation, GlaxoSmithKline, Mayne Pharma, MBF, NHMRC, Novartis, Organon, Servier and the Stanley Medical Research Foundation; has acted as a consultant to AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., GlaxoSmithKline, Janssen-Cilag, Lundbeck and Pfizer; and has served on the speakers bureau for AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., GlaxoSmithKline, Janssen-Cilag, Lundbeck, Organon, Pfizer, Sanofi-Synthelabo, Solvay Pharmaceuticals and Wyeth. PC has received grant funding/research support from Bristol-Myers Squibb, Eli Lilly & Co. and Janssen; however, no commercial association that might pose a conflict of interest in connection with this particular manuscript is reported. GSM has received research support from AstraZeneca, Eli Lilly & Co., Pfizer and Wyeth; and has served on the advisory boards for AstraZeneca, Eli Lilly & Co. and Wyeth. SD has received grant funding or research support from Bristol-Myers Squibb, Eli Lilly & Co., Mayne Pharma, Novartis and Organon. LNY has received grant support from and servers as a speaker and member of the advisory board for Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly & Co., GlaxoSmithKline, Janssen Pharmaceutica, Novartis, Pfizer and Servier. NL, KH, AY and PMcG do not have any reported conflict of interest.

Professor Michael Berk, Barwon Health and Geelong Clinic, Swanston Centre, PO Box 281, Geelong, Victoria, 3220, Australia. Fax: +61 3 5246 5165; e-mail: mikebe@barwonhealth.org.au

Abstract

Bipolar disorder is common, and both difficult to detect and diagnose. Treatment is contingent on clinical needs, which differ according to phase and stage of the illness. A staging model could allow examination of the longitudinal course of the illness and the temporal impact of interventions and events. It could allow for a structured examination of the illness, which could set the stage for algorithms that are tailored to the individuals needs. A staging model could further provide as structure for assessment, gauging treatment and outcomes. The model incorporates prodromal stages and emphasizes early detection and algorithm appropriate intervention where possible. At the other end of the spectrum, the model attempts to operationalize treatment resistance. The utility of the model will need to be validated by empirical research.

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