Bipolar disorder is a recurrent disorder that affects more than 1% of the world population and usually has its onset during youth. Its chronic course is associated with high rates of morbidity and mortality, making bipolar disorder one of the main causes of disability among young and working-age people. The implementation of early intervention strategies may help to change the outcome of the illness and avert potentially irreversible harm to patients with bipolar disorder, as early phases may be more responsive to treatment and may need less aggressive therapies. Early intervention in bipolar disorder is gaining momentum. Current evidence emerging from longitudinal studies indicates that parental early-onset bipolar disorder is the most consistent risk factor for bipolar disorder. Longitudinal studies also indicate that a full-blown manic episode is often preceded by a variety of prodromal symptoms, particularly subsyndromal manic symptoms, therefore supporting the existence of an at-risk state in bipolar disorder that could be targeted through early intervention. There are also identifiable risk factors that influence the course of bipolar disorder, some of them potentially modifiable. Valid biomarkers or diagnosis tools to help clinicians identify individuals at high risk of conversion to bipolar disorder are still lacking, although there are some promising early results. Pending more solid evidence on the best treatment strategy in early phases of bipolar disorder, physicians should carefully weigh the risks and benefits of each intervention. Further studies will provide the evidence needed to finish shaping the concept of early intervention.

AJP AT 175 Remembering Our Past As We Envision Our Future

April 1925: Interpretations of Manic-Depressive Phases

Earl Bond and G.E. Partridge reviewed a number of patients with manic-depressive illness in search of a unifying endo-psychic conflict. They concluded that understanding either phase of illness was “elusive” and “tantalizing beyond reach.” (Am J Psychiatry 1925: 81: 643–662)

躁郁症是一种反复发作的疾病，影响了世界1％以上的人口，通常在青年时期就发病。它的慢性病程与高发病率和死亡率有关，使躁郁症成为年轻人和劳动年龄段的残疾人致残的主要原因之一。早期干预策略的实施可能有助于改变疾病的结局并避免对躁郁症患者的潜在不可逆转的伤害，因为早期阶段可能对治疗反应更敏感，并且可能需要较少的积极治疗。躁郁症的早期干预正在获得发展。来自纵向研究的最新证据表明，父母早发性双相情感障碍是双相情感障碍最一致的危险因素。纵向研究还表明，在躁狂发作全面发作之前通常会出现多种前驱症状，尤其是症状下躁狂症状，因此支持了双相情感障碍中处于高风险状态的存在，可以通过早期干预将其作为治疗目标。还有可识别的危险因素会影响躁郁症的病程，其中一些可能会被改变。尽管有一些令人鼓舞的早期结果，但仍缺乏有效的生物标记物或诊断工具来帮助临床医生识别罹患躁郁症的高风险患者。在躁郁症的早期阶段，最好的治疗策略有更多可靠的证据之前，医生应仔细权衡每种干预措施的风险和益处。

AJP AT 175展望未来时回想我们的过去

1925年4月：对躁狂抑郁期的解释

伯爵·邦德（Earl Bond）和GE·帕特里奇（GE Partridge）回顾了许多躁狂抑郁症患者，以寻求统一的内心心理冲突。他们得出的结论是，了解疾病的任何一个阶段都是“难以捉摸的”和“令人难以置信的诱人”。（Am J Psychiatry 1925：81：643–662）