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Früherkennung und Frühintervention bei bipolaren Störungen

Forschungsstand und Perspektiven

Early recognition and intervention for bipolar disorders

State of research and perspectives

  • Aktuelles aus Diagnostik und Therapie
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Zusammenfassung

Erste Symptome einer sich entwickelnden bipolaren Störung treten häufig bereits in der Adoleszenz oder im frühen Erwachsenalter auf. Dennoch wird die Diagnose oft sehr spät gestellt und dadurch eine adäquate Behandlung verzögert. Die Erfahrung aus der Früherkennung von Psychosen nutzend, sollen durch die Gründung eines deutschsprachigen Netzwerks von Wissenschaftlern der Themenbereiche bipolare Störungen und Früherkennung psychischer Störungen („Network for Early Recognition and Intervention in Bipolar Disorders“, kurz: NERIBID) Synergien gestärkt und für die Erarbeitung gemeinsamer wissenschaftlicher und klinischer Standards und die Planung und Durchführung gemeinsamer Studienprojekte genutzt werden. Initiale gemeinsame Schwerpunkte waren u. a. die Aufarbeitung des aktuellen Forschungsstands sowie die (Weiter)entwicklung von Früherkennungsinstrumenten. Erste Ergebnisse werden im vorliegenden Beitrag dargestellt. Perspektivisch gilt es, zu klären, ob die Früherkennung von Risikostadien für die Entwicklung bipolarer Störungen möglich ist, und wenn ja, welche Frühinterventionen sinnvoll sind. Sollte dies möglich sein, muss die weitere Frage geklärt werden, wie die aktuell meist im Rahmen von Forschungsvorhaben realisierten Früherkennungsinitiativen pragmatisch in der klinischen Versorgungslandschaft etabliert werden können.

Summary

Early signs of developing bipolar disorder are frequently already present in adolescence or early adulthood. Despite this the disorder is often diagnosed late leading to a delay in adequate treatment. Benefiting from the experience of the early recognition of psychosis, we aimed to strengthen synergies by founding a German-speaking network of scientists in the fields of bipolar disorders and early recognition of mental disorders (“Network for Early Recognition and Intervention in Bipolar Disorders”, short: NERIBID) in order to develop joint scientific and clinical standards and design and conduct collaborative study projects. Initial key aspects of establishing the network included a review of the research to date and the (further) development of instruments for early recognition. Preliminary results of these initiatives are presented in this article. In the long term it has to be clarified whether early detection of at-risk states for the development of bipolar disorders is possible and, if so, which early intervention strategies are most appropriate? If it is possible to reliably identify individuals at true risk for bipolar disorder, the next question to be answered is how early detection initiatives that presently are mostly realized within research projects could be established pragmatically within clinical settings in the health care system.

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Literatur

  1. Akiskal HS, Downs J, Jordan P et al (1985) Affective disorders in referred children and younger siblings of manic-depressives. Mode of onset and prospective course. Arch Gen Psychiatry 42(10):996–1003

    Article  PubMed  CAS  Google Scholar 

  2. Akiskal HS, Maser JD, Zeller PJ et al (1995) Switching from ‚unipolar‘ to bipolar II. An 11-year prospective study of clinical and temperamental predictors in 559 patients. Arch Gen Psychiatry 52(2):114–123

    Article  PubMed  CAS  Google Scholar 

  3. Angst J, Gamma A, Endrass J (2003) Risk factors for the bipolar and depression spectra. Acta Psychiatr Scand Suppl (418):15–19

    Article  Google Scholar 

  4. Bauer M, Juckel G, Correll CU et al (2008) Diagnosis and treatment in the early illness phase of bipolar disorders. Eur Arch Psychiatry Clin Neurosci 258(Suppl 5):50–54

    Article  PubMed  Google Scholar 

  5. Bechdolf A (2012) A prospective trial to evaluate at-risk criteria for bipolar disorder. 20. Europäischer Kongress der European Psychiatric Association. Prag, Tschechische Republik

  6. Bechdolf A, Muller H, Stutzer H et al (2011) Rationale and baseline characteristics of PREVENT: a second-generation intervention trial in subjects at-risk (prodromal) of developing first-episode psychosis evaluating cognitive behavior therapy, aripiprazole, and placebo for the prevention of psychosis. Schizophr Bull 37(Suppl 2):111

    Article  Google Scholar 

  7. Bechdolf A, Ratheesh A, Wood SJ et al (2012) Rationale and first results of developing at-risk (prodromal) criteria for bipolar disorder. Curr Pharm Des 18(4):358–375

    Article  PubMed  CAS  Google Scholar 

  8. Beesdo K, Höfler M, Leibenluft E et al (2009) Mood episodes and mood disorders: patterns of incidence and conversion in the first three decades of life. Bipolar Disord 11(6):637–649

    Article  PubMed  Google Scholar 

  9. Berk M, Brnabic A, Dodd S et al (2011) Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early intervention. Bipolar Disord 13(1):87–98

    Article  PubMed  Google Scholar 

  10. Berk M, Hallam K, Lucas N et al (2007) Early intervention in bipolar disorders: opportunities and pitfalls. Med J Aust 187(Suppl 7):11

    Google Scholar 

  11. Chang KD, Dienes K, Blasey C et al (2003) Divalproex monotherapy in the treatment of bipolar offspring with mood and behavioral disorders and at least mild affective symptoms. J Clin Psychiatry 64(8):936–942

    Article  PubMed  CAS  Google Scholar 

  12. Conus P (2012) Development of a scale for the assessment of prodromal states. 20. Europäischer Kongress der European Psychiatric Association. Prag, Tschechische Republik

  13. Conus P, Ward J, Hallam KT et al (2008) The proximal prodrome to first episode mania–a new target for early intervention. Bipolar Disord 10(5):555–565

    Article  PubMed  Google Scholar 

  14. Correll CU, Hauser M, Auther AM et al (2010) Research in people with psychosis risk syndrome: a review of the current evidence and future directions. J Child Psychol Psychiatry 51(4):390–431

    Article  PubMed  Google Scholar 

  15. Correll CU, Penzner JB, Frederickson AM et al (2007) Differentiation in the preonset phases of schizophrenia and mood disorders: evidence in support of a bipolar mania prodrome. Schizophr Bull 33(3):703–714

    Article  PubMed  Google Scholar 

  16. Correll CU, Penzner JB, Lencz T et al (2007) Early identification and high-risk strategies for bipolar disorder. Bipolar Disord 9(4):324–338

    Article  PubMed  Google Scholar 

  17. DelBello MP, Adler CM, Whitsel RM et al (2007) A 12-week single-blind trial of quetiapine for the treatment of mood symptoms in adolescents at high risk for developing bipolar I disorder. J Clin Psychiatry 68(5):789–795

    Article  PubMed  CAS  Google Scholar 

  18. Duffy A, Alda M, Crawford L et al (2007) The early manifestations of bipolar disorder: a longitudinal prospective study of the offspring of bipolar parents. Bipolar Disord 9(8):828–838

    Article  PubMed  Google Scholar 

  19. Duffy A, Alda M, Hajek T et al (2010) Early stages in the development of bipolar disorder. J Affect Disord 121(1–2):127–135

    Google Scholar 

  20. Egeland JA, Hostetter AM, Pauls DL et al (2000) Prodromal symptoms before onset of manic-depressive disorder suggested by first hospital admission histories 679. J Am Acad Child Adolesc Psychiatry 39(10):1245–1252

    Article  PubMed  CAS  Google Scholar 

  21. Egeland JA, Shaw JA, Endicott J et al (2003) Prospective study of prodromal features for bipolarity in well Amish children. J Am Acad Child Adolesc Psychiatry 42(7):786–796

    Article  PubMed  Google Scholar 

  22. Evans L, Akiskal HS, Keck PEJ et al (2005) Familiality of temperament in bipolar disorder: support for a genetic spectrum. J Affect Disord 85(1–2):153–168

    Google Scholar 

  23. Fergus EL, Miller RB, Luckenbaugh DA et al (2003) Is there progression from irritability/dyscontrol to major depressive and manic symptoms? A retrospective community survey of parents of bipolar children 680. J Affect Disord 77(1):71–78

    Article  PubMed  Google Scholar 

  24. Findling RL, Frazier TW, Youngstrom EA et al (2007) Double-blind, placebo-controlled trial of divalproex monotherapy in the treatment of symptomatic youth at high risk for developing bipolar disorder. J Clin Psychiatry 68(5):781–788

    Article  PubMed  CAS  Google Scholar 

  25. Fusar-Poli P, Bonoldi I, Yung AR et al (2012) Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry 69(3):220–229

    Article  PubMed  Google Scholar 

  26. Geller B, Cooper TB, Zimerman B et al (1998) Lithium for prepubertal depressed children with family history predictors of future bipolarity: a double-blind, placebo-controlled study. J Affect Disord 51(2):165–175

    Article  PubMed  CAS  Google Scholar 

  27. Hauser M, Pfennig A, Ozgurdal S et al (2007) Early recognition of bipolar disorder. Eur Psychiatry 22(2):92–98

    Article  PubMed  Google Scholar 

  28. Hillegers MH, Reichart CG, Wals M et al (2005) Five-year prospective outcome of psychopathology in the adolescent offspring of bipolar parents. Bipolar Disord 7(4):344–350

    Article  PubMed  Google Scholar 

  29. Hirschfeld RM, Calabrese JR, Weissman MM et al (2003) Screening for bipolar disorder in the community. J Clin Psychiatry 64(1):53–59

    Article  PubMed  Google Scholar 

  30. Juckel G, Zeschel E, Ozgurdal S et al (2011) Bipolares Prodrom und Temperament: Ergebnisse einer retrospektiven Studie. Jahrestagung der Deutschen Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde. Berlin

  31. Kochman FJ, Hantouche EG, Ferrari P et al (2005) Cyclothymic temperament as a prospective predictor of bipolarity and suicidality in children and adolescents with major depressive disorder. J Affect Disord 85(1–2):181–189

    Google Scholar 

  32. Leopold K, Ritter P, Correll CU et al (2012) Risk constellations prior to the development of bipolar disorders: rationale of a new risk assessment tool. J Affect Disord 136(3):1000–1010

    Article  PubMed  Google Scholar 

  33. Lish JD, Dime-Meenan S, Whybrow PC et al (1994) The National Depressive and Manic-depressive Association (DMDA) survey of bipolar members. J Affect Disord 31(4):281–294

    Article  PubMed  CAS  Google Scholar 

  34. Marshall M, Rathbone J (2011) Early intervention for psychosis. Cochrane Database Syst Rev (6):CD004718

    Google Scholar 

  35. Miklowitz DJ, Chang KD, Taylor DO et al (2011) Early psychosocial intervention for youth at risk for bipolar I or II disorder: a one-year treatment development trial. Bipolar Disord 13(1):67–75

    Article  PubMed  Google Scholar 

  36. Ozgürdal S, Haren E van, Hauser M et al (2009) Early mood swings as symptoms of the bipolar prodrome: preliminary results of a retrospective analysis. Psychopathology 42(5):337–342

    Article  PubMed  Google Scholar 

  37. Pfennig A, Jabs B, Pfeiffer S et al (2011) Versorgungserfahrungen bipolarer Patienten in Deutschland Befragung vor Einführung der S3-Leitlinie zur Diagnostik und Therapie bipolarer Störungen. Nervenheilkunde 5:333–340

    Google Scholar 

  38. Reichart CG, Ende J van der, Wals M et al (2005) The use of the GBI as predictor of bipolar disorder in a population of adolescent offspring of parents with a bipolar disorder. J Affect Disord 89(1–3):147–155

    Google Scholar 

  39. Ritter PS, Marx C, Bauer M et al (2011) The role of disturbed sleep in the early recognition of bipolar disorder: a systematic review. Bipolar Disord 13(3):227–237

    Article  PubMed  Google Scholar 

  40. Rucklidge JJ (2008) Retrospective parent report of psychiatric histories: do checklists reveal specific prodromal indicators for postpubertal-onset pediatric bipolar disorder? Bipolar Disord 10(1):56–66

    Article  PubMed  Google Scholar 

  41. Ruhrmann S, Schultze-Lutter F, Bechdolf A et al (2010) Intervention in at-risk states for developing psychosis. Eur Arch Psychiatry Clin Neurosci 260(Suppl 2):90

    Article  Google Scholar 

  42. Saxena K, Howe M, Simeonova D et al (2006) Divalproex sodium reduces overall aggression in youth at high risk for bipolar disorder. J Child Adolesc Psychopharmacol 16(3):252–259

    Article  PubMed  Google Scholar 

  43. Shaw JA, Egeland JA, Endicott J et al (2005) A 10-year prospective study of prodromal patterns for bipolar disorder among Amish youth. J Am Acad Child Adolesc Psychiatry 44(11):1104–1111

    Article  PubMed  Google Scholar 

  44. Tijssen MJ, Van OJ, Wittchen HU et al (2010) Prediction of transition from common adolescent bipolar experiences to bipolar disorder: 10-year study. Br J Psychiatry 196(2):102–108

    Article  PubMed  Google Scholar 

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Interessenkonflikte

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin:

A.P. hat finanzielle Unterstützung für wissenschaftliche Projekte von GlaxoSmithKline und AstraZeneca sowie Vortragshonorare bzw. Reisekosten für eigene wissenschaftliche Inhalte von AstraZeneca erhalten.

C.C. hat Honorare für Konsultationen von AstraZeneca, Bristol-Myers Squibb, Cephalon, Desitin, Eli Lilly; Gerson Lehrman Group, IntraCellular Therapies, Lundbeck, MedAvante; Medscape, Pfizer; Otsuka, Sunovion, Takeda, und Teva erhalten. Er war Mitglied der Advisory Boards von Actelion; Alexza; AstraZeneca, Biotis, Bristol-Myers Squibb, IntraCellular Therapies, MedAvante, Merck, Novartis, Otsuka, Sunovion, Pfizer, Sunovion. Er hat Vortragshonorare von American Academy of Child and Adolescent Psychiatry, Bristol-Myers Squibb, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Otsuka, ProPhase, und Pfizer erhalten. Zusätzlich hat er Forschungsmittel von BMS, Feinstein Institute for Medical Research, Janssen-Cilag/J&J, National Institute of Mental Health (NIMH), National Alliance for Research in Schizophrenia and Depression (NARSAD), und Otsuka erhalten.

K.L. hat Vortragshonorare von AstraZeneca, BMS, Pfizer, Janssen-Cilag, Lundbeck und Lilly erhalten.

G.J. hat Vortragshonorare von folgenden pharmazeutischen Firmen erhalten: AstraZeneca, Bristol-Myers-Squibb/Otsuka, Janssen, Lilly, Lundbeck, Pfizer. Er war Mitglied der Advisory Boards von AstraZeneca, Bristol-Myers-Squibb/Otsuka, Janssen-Cilag. Er hat finanzielle Unterstützung für IITs bekommen von: Jansen, Astra-Zeneca, Lundbek, BMS.

M.B. hat Vortragshonorare von folgenden pharmazeutischen Firmen erhalten: AstraZeneca, Bristol-Myers-Squibb/Otsuka, Lilly, GlaxoSmithKline, Lundbeck, Servier und Pfizer. Er war Mitglied der Advisory Boards von AstraZeneca, Lilly, Bristol-Myers-Squibb/Otsuka, Lundbeck, Servier, Janssen-Cilag.

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Authors and Affiliations

  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland

    A. Pfennig, K. Leopold &  M. Bauer

  2. The Zucker Hillside Hospital, Psychiatry Research, North Shore – Long Island Jewish Health System, Glen Oaks, New York, USA

    C.U. Correll

  3. Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, Ruhr-Universität Bochum, LWL-Universitätsklinikum, Bochum, Deutschland

    G. Juckel

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  1. A. Pfennig
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  2. C.U. Correll
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  3. K. Leopold
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  4. G. Juckel
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  5. M. Bauer
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Correspondence to M. Bauer.

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Pfennig, A., Correll, C., Leopold, K. et al. Früherkennung und Frühintervention bei bipolaren Störungen. Nervenarzt 83, 897–902 (2012). https://doi.org/10.1007/s00115-012-3589-3

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