期刊
CANADIAN JOURNAL OF PSYCHIATRY-REVUE CANADIENNE DE PSYCHIATRIE
卷 55, 期 8, 页码 477-485出版社
SAGE PUBLICATIONS INC
DOI: 10.1177/070674371005500802
关键词
high-risk studies; bipolar disorder; clinical course; natural history; clinical staging; heterogeneity; early diagnosis; treatment
类别
资金
- Canadian Institutes of Health Research (CIHR)
- National Alliance for Research on Schizophrenia and Depression
- Canada Research Chair in Child Mood Disorders
- Dalhousie Faculty of Medicine
- Ontario Mental Health Foundation
- Astra Zeneca
Longitudinal high-risk research has provided convergent evidence that major mood and psychotic disorders often develop from nonspecific antecedents in predisposed people over time and development. For example, bipolar disorder (BD) appears to evolve from nonspecific childhood antecedents, including anxiety and sleep problems, followed by adjustment and minor mood disturbances through early adolescence, culminating in major mood episodes in later adolescence and early adulthood. Therefore, the current cross-sectional symptom-based diagnostic approach requires rethinking: it considers neither the familial risk nor the longitudinal clinical course, with the consequence that the early stages of illness are not recognized as belonging to the end-stage disorder. Emerging evidence of identifiable clinical stages in the development of BD has tremendous potential for early identification, development of stage-specific treatments, and advancing our understanding of the pathophysiology associated with illness onset and progression. The clinical staging model also has direct implications for the optimal organization of clinical services for high-risk youth. Specifically, specialty psychiatric programs are needed that break down traditional institutional barriers to provide surveillance and timely comprehensive psychiatric assessment during the entire risk period, from childhood through to early adulthood. In this regard, the development of specialty psychiatric programs aiming to identify youth in the early stages of evolving psychosis are substantially ahead of services for youth in the early stages of evolving major mood disorders. Can J Psychiatry. 2010;55(8):477-485.
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