Clinical Staging Models and Risk of Bipolar Disorder

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A major challenge for early intervention psychiatry is to identify those persons who are at increased risk of developing recurrent unipolar or bipolar mood disorders, assuming that such identification will lead to interventions that reduce poor long-term outcomesThis paper will report on subjects attending novel headspace services for young persons with emerging major mental disorders are followed longitudinally, with subsets recruited for more detailed neurobiological studies. Separately, we conduct a longitudinal study of adolescent twins, examining the patterns of emerging comorbidity between depressive, bipolar, psychotic and other substance-abuse related mental disorders.While clinical subjects with early phases of bipolar-type disorders are not readily differentiated from other significant unipolar disorders on clinical characteristics, they are separated by family history of bipolar disorder, some neuroimaging characteristics and a range of features suggesting circadian dysfunction. Evidence from the neuroimaging and circadian studies also suggest that distinct neurobiological features emerge progressively as subjects move from earlier to later stages of illness. The twin studies demonstrate that while motor activation and sleep disturbance features are common in adolescence, by themselves they are not indicative of bipolar or other major mental disorder. Patterns of overlap with other depressive and psychotic disorders suggest that more complex phenotypic presentations may be under stronger genetic control.

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Presentation Date: 
January, 2015
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