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Ethical considerations in preventive interventions for bipolar disorder.

Published on Apr 1, 2017in Early Intervention in Psychiatry3.323
· DOI :10.1111/eip.12340
Aswin Ratheesh11
Estimated H-index: 11
(University of Melbourne),
Sue Cotton43
Estimated H-index: 43
(University of Melbourne)
+ 5 AuthorsPatrick D. McGorry109
Estimated H-index: 109
(University of Melbourne)
Abstract
Aim Early intervention and prevention of serious mental disorders such as bipolar disorder has the promise of decreasing the burden associated with these disorders. With increasing early and preventive intervention efforts among cohorts such as those with a familial risk for bipolar disorder, there is a need to examine the associated ethical concerns. The aim of this review was to examine the ethical issues underpinning the clinical research on pre-onset identification and preventive interventions for bipolar disorder. Methods We undertook a PubMed search updated to November 2014 incorporating search terms such as bipolar, mania, hypomania, ethic*(truncated), early intervention, prevention, genetic and family. Results Fifty-six articles that were identified by this method as well as other relevant articles were examined within a framework of ethical principles including beneficence, non-maleficence, respect for autonomy and justice. The primary risks associated with research and clinical interventions include stigma and labelling, especially among familial high-risk youth. Side effects from interventions are another concern. The benefits of preventive or early interventions were in the amelioration of symptoms as well as the possibility of minimizing disability, cognitive impairment and progression of the illness. Supporting the autonomy of individuals and improving access to stigma-free care may help moderate the potential challenges associated with the risks of interventions. Conclusions Concerns about the risks of early identification and pre-onset interventions should be balanced against the potential benefits, the individuals' right to choice and by improving availability of services that balance such dilemmas.
  • References (75)
  • Citations (5)
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References75
Newest
#1Aswin Ratheesh (University of Melbourne)H-Index: 11
#2Michael BerkH-Index: 93
Last. Sue Cotton (University of Melbourne)H-Index: 43
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Abstract Background Identification of earlier stages of Bipolar Disorder (BD), even prior to the first manic episode, may help develop interventions to prevent or delay the onset of BD. However, reliable and valid instruments are necessary to ascertain such earlier stages of BD. The aim of the current review was to identify instruments that had predictive validity and utility for BD for use in early intervention (EI) settings for the prevention of BD. Methods We undertook a systematic examinatio...
10 CitationsSource
#1Anne Duffy (U of C: University of Calgary)H-Index: 31
Objectives:To describe key findings relating to the natural history and heterogeneity of bipolar disorder (BD) relevant to the development of a unitary clinical staging model. Currently proposed staging models are briefly discussed, highlighting complementary findings, and a comprehensive staging model of BD is proposed integrating the relevant evidence.Method:A selective review of key published findings addressing the natural history, heterogeneity, and clinical staging models of BD are discuss...
42 CitationsSource
#1Jeffrey R. Strawn (UC: University of Cincinnati)H-Index: 23
#2Caleb M. Adler (UC: University of Cincinnati)H-Index: 47
Last. Melissa P. DelBello (UC: University of Cincinnati)H-Index: 63
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OBJECTIVE: Depressive and anxiety disorders are common in youth who are at risk for bipolar disorder (i.e., youth who have at least one parent with bipolar disorder) and antidepressants are commonly prescribed as treatment. However, there are few data regarding the safety and tolerability of antidepressants in this population. Therefore, we sought to prospectively examine the effects of these medications in children and adolescents who are diagnosed with depressive or anxiety disorders and have ...
29 CitationsSource
#2Doreen M. Olvet (SBU: Stony Brook University)H-Index: 25
Last. Barbara A. Cornblatt (Hofstra University)H-Index: 39
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Objective To investigate the psychometric properties of the Bipolar Prodrome Symptom Interview and Scale–Prospective (BPSS-P), the first specific interview for emerging bipolar disorder (BD) symptoms.
35 CitationsSource
#1Andreas BechdolfH-Index: 41
#2Aswin Ratheesh (University of Melbourne)H-Index: 11
Last. Patrick D. McGorry (University of Melbourne)H-Index: 109
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Objectives There are no established tools to identify individuals at risk for developing bipolar disorder. We developed a set of ultra-high-risk criteria for bipolar disorder [bipolar at-risk (BAR)]. The primary aim of the present study was to determine the predictive validity of the BAR criteria. Methods This was a 12-month prospective study that was conducted at Orygen Youth Health Clinical Program, a public mental health program for young people aged 15–24 years in metropolitan Melbourne, Aus...
55 CitationsSource
#1Andrea Pfennig (TUD: Dresden University of Technology)H-Index: 33
#2Karolina Leopold (TUD: Dresden University of Technology)H-Index: 13
Last. Michael Bauer (TUD: Dresden University of Technology)H-Index: 71
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Background Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially d...
13 CitationsSource
#1Jessica A. Erickson (Stanford University)H-Index: 3
#2Lili Kuzmich (UCSF: University of California, San Francisco)H-Index: 4
Last. Douglas F. Levinson (Stanford University)H-Index: 86
view all 7 authors...
Large-scale sequencing information may provide a basis for genetic tests for predisposition to common disorders. In this study, participants in the Coriell Personalized Medicine Collaborative (N = 53) with a personal and/or family history of Major Depressive Disorder or Bipolar Disorder were interviewed based on the Health Belief Model around hypothetical intention to test one’s children for probability of developing a mood disorder. Most participants (87 %) were interested in a hypothetical tes...
4 CitationsSource
#1Anne DuffyH-Index: 31
#2Julie HorrocksH-Index: 20
Last. Paul GrofH-Index: 43
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Background Bipolar disorder is highly heritable and therefore longitudinal observation of children of affected parents is important to mapping the early natural history. Aims To model the developmental trajectory of bipolar disorder based on the latest findings from an ongoing prospective study of the offspring of parents with well-characterised bipolar disorder. Method A total of 229 offspring from families in which 1 parent had confirmed bipolar disorder and 86 control offspring were prospecti...
140 CitationsSource
#1Anne Duffy (U of C: University of Calgary)H-Index: 31
With the recognition that bipolar disorder (BD) develops in a series of predictable clinical stages, clinical and research focus has shifted increasingly into early intervention and prevention. The heritability of BD is estimated to be around 85 %; therefore, children of affected parents are an identifiable and important high-risk group. Lessons from early psychosis and other areas of medicine suggest that education for high-risk families regarding recognizable clinical stages and modifiable ris...
6 CitationsSource
#1Harvey A. Whiteford (Centre for Mental Health)H-Index: 65
#2Louisa Degenhardt (University of Melbourne)H-Index: 91
Last. E. Theo Vos (UW: University of Washington)H-Index: 107
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Summary Background We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the burden of disease attributable to mental and substance use disorders in terms of disability-adjusted life years (DALYs), years of life lost to premature mortality (YLLs), and years lived with disability (YLDs). Methods For each of the 20 mental and substance use disorders included in GBD 2010, we systematically reviewed epidemiological data and used a Bayesian meta...
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#1Boris Birmaher (University of Pittsburgh)H-Index: 93
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Objective Youth with subthreshold mania are at increased risk of conversion to bipolar disorder (BP) I/II. Predictors for conversion have been published for the group as a whole. However, risk factors are heterogeneous, indicating the need for personalized risk assessment. Method One hundred forty youth with BP not otherwise specified (BP-NOS; 6–17 years old) followed through the Course and Outcome of Bipolar Youth (COBY) study with at least 1 follow-up assessment before conversion to BP-I/II we...
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Abstract The implications of biomedical ethics principles extend to both medical care and biomedical research. They are particularly relevant for psychiatry in which pathologies are often chronic and disabling. Bipolar disorders impact the ability to make judgements and to take decisions during mood episodes and remain a stigmatised condition. Early interventions, even those in the prodromal phase, pose ethical questions for both clinicians and researchers. The degree of patients’ autonomy in th...
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#1Sara Allaouat (University of Eastern Finland)
#2Zahra Roustaei (University of Eastern Finland)H-Index: 1
Last. Jani Ruotsalainen (Finnish Institute of Occupational Health)H-Index: 12
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Abstract Objectives The objective of the study was to develop quality indicators for preventive effectiveness and to evaluate their use with Cochrane Reviews of primary preventive interventions. Study Design and Setting Based on the quality of care framework, we searched the literature to develop a set of quality indicators. Two authors applied the quality indicators independently to a sample of Cochrane systematic reviews of primary prevention. Results Five quality indicators were developed: sa...
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#1Gin S. Malhi (USYD: University of Sydney)H-Index: 67
#2Grace Morris (USYD: University of Sydney)H-Index: 7
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