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.

中文翻译：

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如何预防双相情感障碍的恶性进展

人们越来越认识到，在很大比例的情况下，双相情感障碍是一种进行性疾病。多种类型的敏化（或对重复相同刺激的反应性增加）推动疾病进展。最明显的一个是发作致敏，其中先前发作次数的增加与： 更快的复发；更多的功能障碍；失能; 社会、教育和就业赤字；自杀; 医疗合并症；认知功能障碍；和老年痴呆症的发病率增加。压力源的重复和药物滥用也会导致过敏。每种类型的致敏似乎都有表观遗传基础，因此防止致敏应尽量减少不利的表观遗传化学标记在 DNA、组蛋白和微 RNA 上的积累。新数据强调了在最初的躁狂发作后早期、持续干预的重要性。与第一次发作相关的认知功能障碍只有在第二年没有进一步发作复发的情况下才会得到改善。一项随机研究还表明，为期 2 年的综合多模式预防性干预可改善病程长达 6 年。因此，对双相情感障碍早期阶段的强化治疗可以对病程产生持久的积极影响。一项随机研究还表明，为期 2 年的综合多模式预防性干预可改善病程长达 6 年。因此，对双相情感障碍早期阶段的强化治疗可以对病程产生持久的积极影响。一项随机研究还表明，为期 2 年的综合多模式预防性干预可改善病程长达 6 年。因此，对双相情感障碍早期阶段的强化治疗可以对病程产生持久的积极影响。