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The clinical characterization of the adult patient with bipolar disorder aimed at personalization of management
RS. McIntyre, M. Alda, RJ. Baldessarini, M. Bauer, M. Berk, CU. Correll, A. Fagiolini, K. Fountoulakis, MA. Frye, H. Grunze, LV. Kessing, DJ. Miklowitz, G. Parker, RM. Post, AC. Swann, T. Suppes, E. Vieta, A. Young, M. Maj
Jazyk angličtina Země Itálie
Typ dokumentu časopisecké články
NLK
Free Medical Journals
od 2002
PubMed Central
od 2002
Europe PubMed Central
od 2002
Wiley Free Content
od 2008
PubMed
36073706
DOI
10.1002/wps.20997
Knihovny.cz E-zdroje
- Publikační typ
- časopisecké články MeSH
Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.
Allgemeinpsychiatrie Ost Klinikum am Weissenhof Weinsberg Germany
Bipolar Collaborative Network Bethesda MD USA
Copenhagen Affective Disorder Research Center Psychiatric Center Copenhagen Copenhagen Denmark
Department of Child and Adolescent Psychiatry Charité Universitätsmedizin Berlin Berlin Germany
Department of Molecular Medicine University of Siena Siena Italy
Department of Pharmacology University of Toronto Toronto ON Canada
Department of Psychiatry and Psychology Mayo Clinic Rochester MN USA
Department of Psychiatry Baylor College of Medicine Houston TX USA
Department of Psychiatry Dalhousie University Halifax NS Canada
Department of Psychiatry University of Campania L Vanvitelli Naples Italy
Department of Psychiatry University of Toronto Toronto ON Canada
Department of Psychiatry Zucker Hillside Hospital Northwell Health Glen Oaks NY USA
Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
Harvard Medical School Boston MA USA
IMPACT Strategic Research Centre School of Medicine Deakin University Geelong VIC Australia
International Consortium for Bipolar and Psychotic Disorders Research McLean Hospital Belmont MA USA
Mailman Research Center McLean Hospital Belmont MA USA
Mood Disorders Psychopharmacology Unit University Health Network Toronto ON Canada
National Institute of Mental Health Klecany Czech Republic
Paracelsus Medical Private University Nuremberg Nuremberg Germany
School of Medicine and Health Sciences George Washington University Washington DC USA
School of Psychiatry University of New South Wales Sydney NSW Australia
South London and Maudsley NHS Foundation Trust Bethlem Royal Hospital Beckenham UK
University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany
Citace poskytuje Crossref.org
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- $a Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.
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