Neuroprogression and illness trajectories in bipolar disorder

ABSTRACT

Introduction: The longitudinal course of bipolar disorder is highly variable, and a subset of patients seems to present a progressive course associated with brain changes and functional impairment.

Areas covered: We discuss the theory of neuroprogression in bipolar disorder. This concept considers the systemic stress response that occurs within mood episodes and late-stage deficits in functioning and cognition as well as neuroanatomic changes. We also discuss treatment refractoriness that may take place in some cases of bipolar disorder. We searched PubMed for articles published in any language up to June 4^th, 2016. We found 315 abstracts and included 87 studies in our review.

Expert commentary: We are of the opinion that the use of specific pharmacological strategies and functional remediation may be potentially useful in bipolar patients at late-stages. New analytic approaches using multimodal data hold the potential to help in identifying signatures of subgroups of patients who will develop a neuroprogressive course.

KEYWORDS:

• Bipolar disorder
• neuroprogression
• allostatic load
• machine learning
• big data

Acknowledgments

The authors would like to thank the Graduation Program in Psychiatry of the Universidade Federal do Rio Grande do Sul (UFRGS).

Declaration of interest

F Kapczinski has received grants or research support from AstraZeneca, Eli Lilly, Janssen-Cilag, Servier, NARSAD, and the Stanley Medical Research Institute; has been a member of speakers’ boards for AstraZeneca, Eli Lilly, Janssen, and Servier; and has served as a consultant for Servier. M Kauer-Sant’Anna is on speaker or advisory boards for, or has received research grants from NARSAD, Stanley Medical Research Institute, and Eli-Lilly. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.