An overview of prodromal research – a blueprint for Bipolar Disorder?
Early intervention in psychosis is a well established area of research and clinical practice. Recently, the early intervention field has focused on intervening with those at high-risk of psychosis i.e., those who may be putatively prodromal for psychosis. Criteria have been defined to identify those at clinical high-risk for developing a psychosis. These are a mix of recent-onset functional decline plus genetic risk, recent-onset subthreshold or brief-threshold psychotic symptoms. Using these criteria, the risk of converting to psychosis is approximately 20-35% by one year. Thus, clinical high risk populations are now available for tracking prospectively the development and emergence of psychosis. This will expand our ability to identify persons at high risk for imminent psychosis, to refine the predictors of true liability, and to expand understanding of the mechanisms by which schizophrenia unfolds in vulnerable persons. Such knowledge is highly relevant for the success of future efforts at early detection, intervention and prevention of psychotic disorders. These issues have not yet been addressed to the same degree in bipolar disorder. Although some preliminary work has been done to find possible patterns of prodromal bipolarity that may include the onset of sub-threshold symptoms as well as various risk factors, it has been problematic to specifically determine a prodromal bipolar profile that would lead to specific treatment interventions. This presentation will briefly review the current research in the prodrome for psychosis and its relevance for bipolar disorder. Potential avenues for further research into the prodrome of bipolar disorder will be presented.