Treatment of the early stages of bipolar disorder

Current management strategies for bipolar disorder focus on the treatment of acute episodes, relapse prevention and maintenance therapies (National Institute for Health and Clinical Excellence 2006). To date, early intervention in bipolar disorder has received relatively little attention, in contrast to the increasing numbers of articles published in recent years on early intervention in schizophrenia. Bipolar disorder affects about 1% of the population worldwide. A recent international study reported that the median age at onset is 24 years for men and 27 years for women, with a range of 10 to 42 years (Baldessarini 2009). In the majority of patients, bipolar disorder runs a chronic course, associated with significant morbidity in psycho­ logical, social and physical health (Kupfer 2005). The estimated cost of bipolar disorder in the UK is £4.59 billion (estimated 2007 value; Fajutrao 2009), including both direct costs such as those of hospitalisation for acute episodes, and indirect costs such as those of unemployment and suicide.