Staging the bipolar disorders: Are early stages at too early a stage for intervention?

Objectives A number of staging models have been generated for the bipolar disorders, which include pre-onset as well as post-onset stages. Some models propose treatments for those at the pre-onset stage, a recommendation which is critiqued here. Methods Several exemplar staging models are overviewed, and a critique is provided. Results The critique argues against intervention at a pre-onset stage, in light of there being limited risk factors, unquantified sensitivity and specificity data for most putative onset illness risk factors, and thus there is the risk of overtreatment. Also, it is possible that many of the recommended interventions for those at risk of a bipolar disorder may have general non-specific benefits for those at risk. Conclusions While retaining a pre-onset phase in the staging model, it would appear wiser for it to not be populated with recommended interventions until they have a firmer empirical base.

Automated summary

This article evaluates treatment recommendations in staging models for bipolar disorders and provides a critique, suggesting that intervention at the pre-onset stage may pose risks and recommended interventions may have nonspecific benefits. Therefore, more empirical research is needed to support these treatment recommendations.