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Background: Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II. Methods: We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the ‘early course’ of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach. Results: From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course. Conclusions and recommendations: While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness cou

Background: Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II. Methods: We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the ‘early course’ of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach. Results: From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course. Conclusions and recommendations: While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness cou

Background: Given the likelihood of progressive illness in bipolar disorder (BD), it is important to understand the benefits and risks of interventions administered early in illness course. We conducted a systematic review of the effectiveness of interventions in the early course of BD I or II. Methods: We completed a systematic search on MEDLINE, PsycINFO, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL and Google Scholar from 1/1/1979 till 14/9/2022. We included controlled trials examining intervention effects on symptomatic, course, functional and tolerability outcomes of patients in the ‘early course’ of BD I or II. We classified patients to be in early course if they (a) were seeking help for the first time for a manic episode, (b) had a lifetime history of up to 3 manic episodes, or (c) had up to 6 lifetime mood episodes. Evidence quality was assessed using the GRADE approach. Results: From 4135 unique publications we included 25 reports representing 2212 participants in 16 randomized studies, and 17,714 participants from nine non-randomized studies. Available evidence suggested that in early illness course, lithium use was associated with lower recurrence risk compared with other mood stabilizers. Mood stabilizers were also associated with better global functioning, compared with the use of antipsychotics in the medium term. While summative findings regarding psychological therapies were limited by heterogeneity, family-focused and cognitive-behavioral interventions were associated with reduced recurrence risk or improved symptomatic outcomes. There was some evidence that the same pharmacological interventions were more efficacious in preventing recurrences when utilized in earlier rather than later illness course. Conclusions and recommendations: While there are promising initial findings, there is a need for more adequately powered trials to examine the efficacy and tolerability of interventions in youth and adults in early illness cou

Objectives: Over the past two decades, there has been tremendous growth in research regarding bipolar disorder (BD) among children and adolescents (ie, pediatric BD [PBD]). The primary purpose of this article is to distill the extant literature, dispel myths or exaggerated assertions in the field, and disseminate clinically relevant findings. Methods: An international group of experts completed a selective review of the literature, emphasizing areas of consensus, identifying limitations and gaps in the literature, and highlighting future directions to mitigate these gaps. Results: Substantial, and increasingly international, research has accumulated regarding the phenomenology, differential diagnosis, course, treatment, and neurobiology of PBD. Prior division around the role of irritability and of screening tools in diagnosis has largely abated. Gold-standard pharmacologic trials inform treatment of manic

Objectives: We tested the diagnostic efficiency of the DSM-oriented Child and Adolescent Symptom Inventory (CASI-4) ADHD symptom subscales for screening ADHD Combined, Hyperactive-impulsive and Inattentive subtype in a pediatric outpatient sample. Methods: Participants were 707 first-time utilizer at nine outpatient mental health clinics aged 6.0-12.9 years (M = 9.36, SD = 1.90) who completed the baseline Longitudinal Assessment of Manic Symptoms study assessments. Consensus diagnoses were based on KSADS interviews of both youth and caregivers. Caregivers completed the CASI-4 ADHD subscales Inattention, Hyperactivity and Combined as predictors. To maximize clinical utility we report diagnostic likelihood ratios (DLRs). Results: Using receiver operating characteristic analysis, the Area under the Curve (AUC) for the Combined subscale was .79 (95 % CI .78 - .81) for screening ADHD-Combined. CASI-4 Hyperactivity subscale AUCs for screening ADHD-Hyperactive-impulsive and ADHD-Combined were .70 (95 % CI .66 - .76) and .82 (95 % CI .80- .84) respectively. CASI-4 Inattentive subscales AUCs for screening ADHD-Inattentive and ADHD-Combined were .77 (95 % CI .74 - .79) and .71 (95 % CI .69 - .73). ROC curve tests comparisons will be provided. A cut score of 40 + was identified as the optimal threshold (DLR of 3.7) for screening ADHD-Combined with the CASI-4 Combined in children ages 6-13 seen in outpatient settings. Conclusions: CASI-4 ADHD subscales are clinically useful to screen for ADHD symptoms in children because of their brevity and economy. However, clinicians should be cautious when interpreting results and should include other data to reach an accurate diagnosis.

Objectives: We tested the diagnostic efficiency of the DSM-oriented Child and Adolescent Symptom Inventory (CASI-4) ADHD symptom subscales for screening ADHD Combined, Hyperactive-impulsive and Inattentive subtype in a pediatric outpatient sample. Methods: Participants were 707 first-time utilizer at nine outpatient mental health clinics aged 6.0-12.9 years (M = 9.36, SD = 1.90) who completed the baseline Longitudinal Assessment of Manic Symptoms study assessments. Consensus diagnoses were based on KSADS interviews of both youth and caregivers. Caregivers completed the CASI-4 ADHD subscales Inattention, Hyperactivity and Combined as predictors. To maximize clinical utility we report diagnostic likelihood ratios (DLRs). Results: Using receiver operating characteristic analysis, the Area under the Curve (AUC) for the Combined subscale was .79 (95 % CI .78 - .81) for screening ADHD-Combined. CASI-4 Hyperactivity subscale AUCs for screening ADHD-Hyperactive-impulsive and ADHD-Combined were .70 (95 % CI .66 - .76) and .82 (95 % CI .80- .84) respectively. CASI-4 Inattentive subscales AUCs for screening ADHD-Inattentive and ADHD-Combined were .77 (95 % CI .74 - .79) and .71 (95 % CI .69 - .73). ROC curve tests comparisons will be provided. A cut score of 40 + was identified as the optimal threshold (DLR of 3.7) for screening ADHD-Combined with the CASI-4 Combined in children ages 6-13 seen in outpatient settings. Conclusions: CASI-4 ADHD subscales are clinically useful to screen for ADHD symptoms in children because of their brevity and economy. However, clinicians should be cautious when interpreting results and should include other data to reach an accurate diagnosis.