[Beyond psychosis: the challenge of early intervention in bipolar disorders].

Historically, mental health services were designed to meet the needs of individuals with persistent psychoses. This strategy arose because schizophrenia was invariably regarded as a chronic neuro-developmental disorder with limited prospects for symptomatic or functional recovery. In contrast, manic depression (or bipolar disorder; BP) was viewed as an intermittent, cyclical disorder associated with full inter-episode recovery that often occurred in otherwise high functioning individuals. Although contemporary clinical studies have suggested that the perceived outcomes for psychosis were unduly pessimistic and those for BP were overly optimistic, mental health service innovations have still tended to be judged by their ability to deliver optimal care and treatment to individuals with schizophrenia. Thus it was understandable that the most radical revision of our approach to mental disorders in recent decades, the ‘early intervention’ movement, initially targeted individuals at ultra-high risk of, or in the early stages of a first episode of psychosis. Few would argue against this philosophy, as schizophrenia is one of the most devastating chronic diseases of adolescence and young adulthood. However, having now established early intervention services for psychosis, an obvious question is whether we can or should adapt the model for individuals with early onset BP. This paper will review the rationale for early intervention in BP and identify some of the challenges that will need to be