A clinical entity with major therapeutic implication: The early onset bipolar disorder

作者：Geoffroy Pierre Alexis^*; Etain Bruno; Leboyer Marion; Bellivier Frank

来源：Annales Medico-Psychologiques, 2012, 170(7): 502-509.

DOI：10.1016/j.amp.2012.07.005

• Admixture
• Bipolar disorder
• Early onset
• Marker
• Subgroup
• Therapeutic

Objectives. Bipolar affective disorder (BPAD) is a multifactorial disorder with heterogeneous clinical presentation, in particular according to age at onset (AAO). AAO has been discussed as a potential specifier in future nosographical classification and may be included in future algorithms of treatment decisions.
Methods. The present article provides a comprehensive review of existing clinical data on age at onset and on pharmacological strategies in early onset BPAD.
Results. Seven admixtures studies have demonstrated the existence of three subgroups of BPAD individuals according to AAO (early, intermediate and late AAO) with two cut-off points of 21 (21.28 years +/- 1.6) and 33 years (33.57 years +/- 5.8). Differential clinical features and outcomes have characterized the early onset subgroup: higher rate of suicide attempts, rapid cycles, alcohol and drugs abuse, psychotic symptoms and co-morbid anxiety disorders. This might partially explain the delayed diagnosis and mood stabilizer initiation. Implementation of AAO in the algorithms of treatment might be discussed although the level of proof for focused medications strategies remains to be consolidated. Targeted prevention of specific comorbidities also should be strongly recommended.
Conclusion. Given the high frequency of early onset BPAD, awareness of clinicians should be stimulated in order to provide an early and accurate detection, preventive strategies and possibly specific cares.

• 出版日期2012-9