Skip to main content Accessibility help
×
Home

Intervening early in bipolar disorder in young people: a review of the clinical staging model

  • P. Power (a1)

Abstract

Bipolar disorder (BPD) essentially has its onset during adolescence and early adulthood. It has the capacity to be highly disruptive, dislocating individuals from their normal developmental trajectory and potentially causing significant long-term co-morbidity and chronicity. At a societal level the burden created is greater than schizophrenia. This is not helped by the very substantial delays in its diagnosis and appropriate treatment. Thus, there is a clear rationale for intervening earlier and at a younger age. However, the field of early intervention in BPD is in its infancy. One approach that conceptually provides a basis for early intervention is the Clinical Staging Model (used widely in general medicine). This article outlines how this model helps in an understanding of the emerging stages of BPD. It also summarises the interventions that might be appropriately introduced if a person progresses from an early to a late stage of the illness. Early intervention has a well-established record in psychotic disorders. If it can be realised for BPDs, then it may hold out hope of better outcomes for the next generation of young people at risk.

Copyright

Corresponding author

*Address for correspondence: Dr P. Power, Young Adult Service, St Patrick’s University Hospital, James St. Dublin 8, Ireland. (Email: ppower@stpatsmail.com)

References

Hide All
Altamura, AC, Buoli, M, Albano, A, Dell’Osso, B (2010). Age at onset and latency to treatment (duration of untreated illness) in patients with mood and anxiety disorders: a naturalistic study. International Clinical Psychopharmacology 25, 172179.
Baldessarini, R, Tondo, L, Baethge, C, Lepri, B, Bratti, I (2007). Effects of treatment latency on response to maintenance treatment in manic-depressive disorders. Bipolar Disorder 9, 386393.
Baldessarini, R, Tondo, L, Tohen, M (2012). Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients. World Psychiatry 11, 4046.
Barnett, JH, Smoller, JW (2009). The genetics of bipolar disorder. Neuroscience 164, 331343.
Bechdolf, A, Ratheesh, A, Cotton, SM, Nelson, B, Chanen, AM, Betts, J, Bingmann, T, Yung, AR, Berk, M, McGorry, PD (2014). The predictive validity of bipolar at-risk (prodromal) criteria in help seeking adolescents and young adults: a prospective study. Bipolar Disorders 16, 493504.
Berk, M, Berk, L, Cotton, S, Macneil, C, Daglas, R, Conus, P, Bechdolf, A, Moylan, S, Malhi, GS (2014). Stage managing bipolar disorder. Bipolar Disorders 16, 471477.
Berk, M, Brnabic, A, Dodd, S, Kelin, K, Tohen, M, Malhi, GS, Berk, L, Conus, P, McGorry, PD (2011). Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model of early intervention. Bipolar Disorders 13, 8798.
Berk, M, Conus, P, Lucas, N, Hallam, K, Malhi, GS, Dodd, S, Yatham, LN, Yung, A, McGorry, P (2007b). Setting the stage: from prodrome to treatment resistance in bipolar disorder. Bipolar Disorder 9, 671678.
Berk, M, Dodd, S, Callaly, P, Berk, L, Fitzgerald, P, de Castella, AR, Filia, S, Filia, K, Tahtalian, S, Biffin, F, Kelin, K, Smith, M, Montgomery, W, Kulkarni, J (2007a). History of illness prior to a diagnosis of bipolar disorder or schizoaffective disorder. Journal of Affective Disorders 103, 181186.
Bukh, JD, Bock, C, Vinberg, M, Kessing, LV (2013). The effect of prolonged duration of untreated depression in antidepressant treatment outcome. Journal of Affective Disorders 145, 4248.
Colom, F (2008). Long-term follow-up of psychotherapies in bipolar disorder. Bipolar Disorder 10 (Suppl. 1): 20.
Conus, P, Berk, M, McGorry, PD (2006). Pharmacological treatment in the early phase of bipolar disorders: what stage are we at? Australian & New Zealand Journal of Psychiatry 40, 199207.
Conus, P, Macneil, C, McGorry, PD (2014). Public health significance of bipolar disorder: implications for early intervention and prevention. Bipolar Disorder 16, 548556.
Conus, P, McGorry, PD (2002). First episode mania: a neglected priority for early intervention. Australian & New Zealand Journal of Psychiatry 36, 158172.
Conus, P, Ward, J, Hallam, KT, Lucas, N, Macneil, C, McGorry, PD, Berk, M (2008). The proximal prodrome to first episode mania – a new target for early intervention. Bipolar Disorder 10, 555565.
Conus, P, Ward, J, Lucas, N, Cotton, S, Yung, AR, Berk, M, McGorry, PD (2010). Characterisation of the prodrome to a first episode of psychotic mania: results of a retrospective study. Journal of Affective Disorders 124, 341345.
Correll, CU, Hauser, M, Penzer, JB, Auther, AM, Kafantaris, V, Saito, E, Olvet, D, Carrion, RE, Birmaher, B, Chang, KD, DelBello, MP, Singh, MK, Pavuluri, M, Cornblatt, BA (2014a). Type and duration of subsyndromal symptoms in youth with bipolar I disorder prior to their first manic episode. Bipolar Disorders 16, 478492.
Correll, CU, Olvet, DM, Auther, AM, Hauser, M, Kishimoto, T, Carrion, RE, Snyder, S, Cornblatt, BA (2014b). The bipolar prodrome symptom interview and scale-prospective (BPSS-P): description and validation in a psychiatric sample and healthy controls. Bipolar Disorders 16, 505522.
Correll, CU, Penzner, JB, Lencz, T, Auther, A, Smith, CW, Malhotra, AK, Kane, JM, Cornblatt, BA (2007). Early identification and high-risk strategies for bipolar disorder. Bipolar Disorder 9, 324338.
Culebra, NC (2010). Early intervention in bipolar disorder: first episodes’ designs and staging utility. Early Intervention in Psychiatry 4, 17511785.
DelBello, MP, Hanseman, D, Adler, CM, Fleck, D, Strakowski, S (2007). Twelve-month outcome of adolescents with bipolar disorder following first hospitalization for a manic or mixed episode. American Journal of Psychiatry 164, 582590.
DelBello, MP, Soutullo, CA, Hendricks, W, Niemeier, RT, McElroy, SL, Strakowski, SM (2001). Prior stimulant treatment in adolescents with bipolar disorder: association with age at onset. Bipolar Disorders 3, 5357.
Demmo, C, Melle, IM, Kvitland, LK, Andreassen, DAA, Vik Lagerberg, TVK, Ueland, TU (2014). Neurocognitive performance in first episode bipolar I disorder compared to first episode schizophrenia and healthy controls. Bipolar Disorders 16 (Suppl. 1): 104.
Douglas, J, Scott, J (2014). A systematic review of gender-specific rates of unipolar and bipolar disorders in community studies of pre-pubertal children. Bipolar Disorder 16, 515.
Drancourt, N, Etain, B, Lajnef, M, Henry, C, Raust, A, Cochet, B, Mathieu, F, Gard, S, Mbailara, K, Zanouy, L, Kahn, JP, Cohen, RF, Wajsbrot-Elgrabli, O, Leboyer, M, Scott, J, Bellivier, F (2013). Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment. Acta Psychiatrica Scandinavica 127, 136144.
Duffy, A, Alda, M, Crawford, L, Milin, R, Grof, P (2007). The early manifestations of bipolar disorder: a longitudinal study of the offspring of bipolar parents. Bipolar Disorder 9, 828838.
Elanjithara, TE, Frangou, S, McGuire, P (2011). Treatment of the early stages of bipolar disorder. Advances in Psychiatric Treatment 17, 283291.
First, M (2009). Harmonisation of ICD-11 and DSM-V: opportunities and challenges. The British Journal of Psychiatry 195, 382390.
Forty, L, Smith, D, Jones, L, Caesar, S, Cooper, C, Fraser, C, Gordon-Smith, K, Hyde, S, Farmer, A, McGuffin, P, Craddock, N (2008). Clinical differences between bipolar and unipolar depression. British Journal of Psychiatry 192, 388389.
Fristad, MA, Gavazzi, SM, Mackinaw-Koons, B (2003). Family psychoeducation: an adjunctive intervention for children with bipolar disorder. Biological Psychiatry 53, 10001008.
Geller, B, Luby, J (1997). Child and adolescent bipolar disorder: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry 36, 11681176.
Geller, B, Zimmerman, B, Williams, M, Bolhofner, K, Craney, JL (2001). Bipolar disorder a prospective follow-up of adults who had prepubertal major depressive disorder. American Journal of Psychiatry 158, 125127.
Ghouse, AA, Sanches, M, Zunta-Soares, G, Swann, AC, Soares, JC (2013). Overdiagnosis of bipolar disorder: a critical analysis of the literature. The Scientific World Journal, Article ID 297087, 2013, 5pp.
Gildengers, AG, Chung, KH, Huang, SH, Begley, A, Aizenstein, HJ, Tsai, SY (2014). Neuroprogressive effects of lifetime illness duration in older adults with bipolar disorder. Bipolar Disorders 16, 617623.
Gitlin, M (2006). Treatment-resistant bipolar disorder. Molecular Psychiatry 11, 227240.
Goldberg, JF, Harrow, M, Whiteside, JE (2001). Risk for bipolar illness in patients initially hospitalized for unipolar depression. American Journal of Psychiatry 158, 12651270.
Gonzalez, S, Artal, J, Gomez, E, Caballero, P, Mayoral, J, Moreno, T, Alvarez-Jimenez, M, Gook, S, Villacorta, MC, Higuera, A, Vazquez-Barquero, JL (2012). Early intervention in bipolar disorder: the Jano program at Hospital Universitario Marques de Valdecilla. Actas Espanolas de Psiquiatria 40, 5156.
Gore, FM, Bloem, GC, Patton, GC, Ferguson, J, Joseph, V, Coffey, C, Sawyer, SM, Mathers, CD (2011). Global burden of disease in young people aged 10-24 years: a systematic analysis. Lancet 377, 20932102.
Hasty, MK, Macneil, CA, Kader, LF, Lucas, N, Hallam, KT, O’Regan, M, Berk, M, McGorry, PD, Conus, P (2006). The developmental considerations for psychological treatment of first episode bipolar disorder, 5th International Conference on Early Psychosis, October, Birmingham, England.
Howes, OD, Falkenberg, I (2011). Early detection and intervention in bipolar affective disorder: targeting the development of the disorder. Current Psychiatry Reports 13, 493499.
Joffe, RT, MacQueen, GM, Marriott, M, Young, LT (2004). A prospective, longitudinal study of percentage of time spent ill in patients with bipolar I or bipolar II disorders. Bipolar Disorder 6, 6266.
Keller, MB, Lavori, PW, Coryell, W, Endicott, J, Mueller, TI (1993). Bipolar I: a five-year prospective follow-up. Journal of Nervous & Mental Disease 181, 238245.
Kessing, LV, Hansen, HV, Christensen, EM, Dam, H, Gluud, C, Wetterslev, J, The Early Intervention Affective Disorders (EIA) Trial Group (2014a). Do young adults with bipolar disorder benefit from early intervention. The Journal of Affective Disorders 152–154, 403408.
Kessing, LV, Hansen, HV, Hvenegaard, A, Christensen, EM, Dam, H, Gluud, C, Wetterslev, J, The Early Intervention Affective Disorders (EIA) Trial Group (2013). Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. British Journal of Psychiatry 202, 212219.
Kessing, LV, Hansen, MG, Andersen, PK (2004). Course of illness in depressive and bipolar disorders. Naturalistic study, 1994–1999. British Journal Psychiatry 185, 372377.
Kessing, LV, Vradi, E, Andersen, PK (2014b). Starting lithium prophylaxis early v. late in bipolar disorder. British Journal of Psychiatry 205, 214220.
Kroon, JS, Wohlfarth, TD, Dieleman, J, Sutterland, AL, Storosum, JG, Denys, D, de Haan, L, Sturkenboom, MCJM (2013). Incidence rates and risk factors of bipolar disorder in the general population: a population-based cohort study. Bipolar Disorders 15, 306313.
Lam, D, McCrone, P, Wright, K, Kerr, N (2008). Cost-effectiveness of relapse prevention cognitive therapy for bipolar disease: 30-month study. British Journal of Psychiatry 186, 500506.
Lambert, M, Conus, P, Lambert, T, McGorry, PD (2003). Pharmacotherapy of first episode psychosis. Expert Opinion in Pharmacotherapy 4, 133.
Laursen, TM (2011). Life expectancy among persons with schizophrenia and bipolar affective disorder. Schizophrenia Research 131, 101104.
Leboyer, M, Henry, C, Paillere-Martinot, ML, Bellivier, F (2005). Age at onset in bipolar affective disorders: a review. Bipolar Disorders 7, 111118.
Leibenluft, E, Dickstein, D (2008). Bipolar disorder in children and adolescents. In Rutter’s Child and Adolescent Psychiatry, 5th edn. (ed. M Rutter, D Bishop, D Pine, S Scott, J Stevenson, E Taylor and A Thapar), pp. 613627. Blackwell Publishing: Oxford, UK.
Lichtenstein, P, Yip, BH, Björk, C, Pawitan, Y, Cannon, TD, Sullivan, PF, Hultman, CM (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based study. Lancet 373, 234239.
Luby, JL, Navsaria, N (2010). Pediatric bipolar disorder: evidence for prodromal states and early markers. Journal of Child Psychology and Psychiatry 51, 459471.
Macmillan, I, Howells, L, Kale, K, Hackmann, C, Taylor, G, Hill, K, Bradford, S, Fowler, D (2007). Social and symptomatic outcomes of first-episode bipolar psychoses in an early intervention service. Early Intervention in Psychiatry 1, 7987.
Macneil, C, Hasty, M, Conus, P, Berk, M, Scott, J (2009). Bipolar Disorder in Young People: A Psychological Intervention Manual. Cambridge University Press: Cambridge.
Macneil, C, Hasty, M, Cotton, S, Berk, M, Hallam, K, Kader, L, McGorry, P, Conus, P (2012). Can a targeted psychological intervention be effective for young people following a first manic episode? Results from an 18-month pilot study. Early Intervention in Psychiatry 6, 380388.
Malhi, GS, Bargh, DM, Coulston, CM, Das, P, Berk, M (2014). Predicting bipolar disorder on the basis of phenomenology: implications for prevention and early intervention. Bipolar Disorders 16, 455470.
Martinez-Aran, A, Vieta, E, Colom, F, Reinares, M, Benanarre, A, GAasto, C, Salamero, M (2000). Cognitive dysfunction in bipolar disorder: evidence of neuropsychological disturbances. Psychotherapy and Psychosomatics 69, 218.
McCraw, S, Parker, G, Graham, R, Synnott, H, Mitchell, PB (2014). The duration of untreated bipolar disorder: effects on outcomes and treatment response. Journal of Affective Disorder 168, 422429.
McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S (2008). Paying The Price: The Cost of Mental Health Care in England to 2026. The King’s Fund: London.
McGorry, PD, Hickie, IB, Yung, AR, Pantelis, C, Jackson, HJ (2006). Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Australian & New Zealand Journal of Psychiatry 40, 616622.
McIntyre, RS, Cha, DS, Jerrell, JM, Swardfager, W, Kim, RD, Costa, LG, Baskaran, A, Soczynska, JK, Woldeyohannes, HO, Mansur, RB, Brietzke, E, Powell, AM, Gallaugher, A, Kuldow, P, Kaidanovich-Beilin, O, Alsuwaidan, M (2014). Advancing biomarker research: utilising ‘Big Data’ approaches for the characterisation and prevention of bipolar disorder. Bipolar Disorders 16, 531547.
McNamara, RK, Nandagopal, JJ, Strakowski, SM, Del-Bello, MP (2010). Preventative strategies for early-onset bipolar disorder: toward a clinical staging model. CNS Drugs 24, 983996.
Meiser, B, Mitchell, PB, McGirra, H, Van Hertend, M, Schofield, PR (2005). Implications of genetic risk information in families with a high density of bipolar disorder: an exploratory study. Social Science & Medicine 60, 109118.
Merikangas, KR, Akiskal, HS, Angst, J, Greenberg, PE, Hirschfeld, RMA, Petukhova, M, Kessler, RC (2007). Lifetime and 12-month prevalence of bipolar spectrum disorder in the national co-morbidity survey replication. Archives of General Psychiatry 64, 543552.
Miklowitz, DJ, Chang, KD, Taylor, DO, George, EL, Singh, MK, Schneck, CD, Dickinson, LM, Howe, ME, Garber, J (2011). Early psychosocial intervention for youth at risk for bipolar I or II disorder: a one-year treatment development trial. Bipolar Disorders 13, 6775.
Miklowitz, DJ, Goldstein, MJ (1997). Bipolar Disorder: A Family-Focused Treatment Approach. The Guilford Press: New York.
Miklowitz, DJ, Otto, MW, Frank, E, Reilly-Harrington, NA, Wisniewski, SR, Kogan, JN, Nierenberg, AA, Calabrese, JR, Marangell, LB, Gyulai, L, Araga, M, Gonzalez, JM, Shirley, ER, Thase, ME, Sachs, GS (2007). Psychosocial treatments for bipolar depression: a 1-year randomized trial from the systematic treatment enhancement program. Archives of General Psychiatry 64, 419427.
Mitchell, PB, Goodwin, GM, Johnson, GF, Hirchfield, R (2008). Diagnostic guidelines for bipolar depression: a probabilistic approach. Bipolar Disorders 10, 144152.
Mohammad, O, Osser, DN (2014). The psychopharmacology algorithm project at the Harvard South shore program: an algorithm for acute mania. Harvard Review Psychiatry 22, 274294.
Moreno, C, Laje, G, Blanco, C, Jiang, H, Schmidt, AB, Olfson, M (2007). National trends in outpatient diagnosis and treatment of bipolar disorder in youth. Archives of General Psychiatry 64, 10321039.
Moreno, D (2014). Prevalence and characteristics of suicide in bipolar disorder. Bipolar Disorders 16 (Suppl. 1): 44.
Nadkarni, RB, Fristad, MA (2010). Clinical course of children with a depressive spectrum disorder and transient manic symptoms. Bipolar Disorders 12, 494503.
Nivoli, A, Murru, A, Goikolea, J, Crespo, J, Montes, J, González-Pinto, A, García-Portilla, P, Bobes, J, Sáiz-Ruiz, J, Vieta, E (2012). New treatment guidelines for acute bipolar mania: a critical review. Journal of Affective Disorders 140, 125141.
Pavuluri, MN, Graczyk, PA, Henry, DB, Carbray, JA, Heidenreich, J, Miklowitz, DJ (2004). Child and family-focused cognitive behavioural therapy for pediatric bipolar disorder: development and preliminary results. Journal of the American Academy of Child and Adolescent Psychiatry 43, 528537.
Perlis, RH, Miyahara, S, Marangell, LB, Wisniewski, SR, Ostacher, M, DelBelloe, MP, Bowden, CL, Sachs, GS, Nierenberg, AA (2004). Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biological Psychiatry 55, 875881.
Perroud, N, Cordera, P, Zimmermann, J, Michalopoulos, G, Bancila, V, Prada, P, Dayer, A, Aubry, JM (2014). Comorbidity between attention deficit hyperactivity disorder (ADHD) and bipolar disorder in a specialized mood disorders outpatient clinic. Journal of Affective Disorders 168, 161166.
Perry, A, Tarrier, N, Morriss, R, McCarthy, E, Limb, K (1999). Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. British Medical Journal 318, 149153.
Pfennig, A, Leopold, K (2014). Identification, characteristics and naturalistic treatment of individuals at-risk for bipolar disorder: results from the first 3 years of the Dresden high-risk program. Bipolar Disorders 16 (Suppl. 1): 27.
Pfennig, A, Schlattmann, P, Alda, M, Grof, P, Glenn, T, Muller-Oerlinghausen, B, Suwalska, A, Rybakowski, J, Willich, SN, Bauer, M, Berghöfe, A (2010). Influence of atypical features on the quality of prophylactic effectiveness of long-term lithium treatment in bipolar disorders. Bipolar Disorders 12, 390396.
Pope, M, Dudley, R, Scott, J (2007). Determinants of social functioning in bipolar disorder. Bipolar Disorders 9, 3844.
Post, R, Luckenbaugh, D, Grunze, H, Nolen, W, Keck, P, Leverich, G, Suppes, T, McElroy, S, Kupka, R, Rowe, Altshuler, L (2010). Bipolar disorder in U.S. versus Europe. Neuropsychopharmacology 35, S166S167.
Power, P, Conus, P, Macneil, C, Scott, J (2014). Early intervention in bipolar disorder. In Early Intervention in Psychiatry: EI of Nearly Everything for Better Mental Health (ed. Peter Byrne and Alan Rosen), chapter 21, pp. 267287. Wiley Blackwell Press: London.
Power, P, Elkins, K, Adlard, S, Curry, C, McGorry, P, Harrigan, S (1998). Analysis of the initial treatment phase in first-episode psychosis. British Journal of Psychiatry 172 (Suppl. 33): 7176.
Power, P, McGorry, PD (2011). Early intervention in psychotic disorder. In Oxford Textbook of Community Mental Health (ed. G Thornicroft, G Szmukler, K Mueser and B Drake), pp. 129138. Oxford University Press: New York.
Psychiatric GWAS Consortium Bipolar Disorder Working Group (2011). Large-scale genome-wide association analysis of bipolar disorder identifies a new susceptibility locus near ODZ4. Nature Genetics 43, 977983.
Schaffer, A, Sinyor, M, Reis, C, Goldstein, BI, Levitt, AJ (2014). Suicide in bipolar disorder: characteristics and subgroups. Bipolar Disorders 16 (Suppl. 1): 122.
Scott, J (2012). Beyond psychosis: the challenge of early intervention in bipolar disorders. Revista de Psiquiatria y Salud Mental (Barc.) 5, 14.
Scott, J, Leboyer, M, Hickie, I, Berk, M, Kapczinski, F, Frank, E, Kupfer, D, McGorry, P (2013). Clinical staging in psychiatry: a cross-cutting model of diagnosis with heuristic and practical value. British Journal of Psychiatry 202, 243245.
Scott, J, Paykel, E, Morris, R, Bentall, R, Kinderman, P, Johnson, T, Abbott, R, Hayhurst, H (2006). Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial. British Journal of Psychiatry 188, 313320.
Strakowski, SM, Williams, JR, Fleck, DE, Delbello, MP (2000). Eight month functional outcome from mania following a first psychiatric hospitalization. Journal of Psychiatric Research 34, 193200.
Strawn, JR, Adler, CM, McNamara, RK, Welge, JA, Bitter, SM, Mills, NP, Barzam, DH, Cerullo, MA, Chang, KD, Strakowski, SM, DelBello, MP (2014). Antidepressant tolerability in anxious and depressed youth at high risk for bipolar disorder: a prospective naturalistic treatment study. Bipolar Disorders 16, 525530.
Swann, A (2010). Bipolar disorder in early adulthood: clinical challenges and emerging evidence. In Young Adult Mental Health (ed. Jon E. Grant and Marc N. Potenza), pp. 379396. Oxford University Press: New York.
Tohen, M, Zarate, CA, Hennen, J, Khalsa, H-M K, Strakowski, S, Gebre-Medhin, P, Salvatore, P, Baldessarini, RJ (2003). The McLean-Harvard first-episode mania study: prediction of recovery and first recurrence. American Journal of Psychiatry 160, 20992107.
Tondo, L, Baldessarini, RJ, Floris, G (2001). Long-term clinical effectiveness of lithium maintenance treatment in types I and II bipolar disorders. British Journal of Psychiatry 178 (Suppl. 41): s184s190.
Tondo, L, Visioli, C, Preti, A, Baldessarini, RJ (2014). Bipolar disorders following initial depression: modeling predictive clinical factors. Journal of Affective Disorders 167, 4449.
Zimmerman, M, Morgan, T (2013). Problematic boundaries in the diagnosis of bipolar disorder: the interface with borderline personality disorder. Current Psychiatry Report 15 pp. 110.

Keywords

Intervening early in bipolar disorder in young people: a review of the clinical staging model

  • P. Power (a1)

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed