Diversity at EPA 2015

These issues range from debates over the naming of psychotropic treatments to investigations into genetic risk of bipolar disorder in children of sufferers, research with potentially huge impacts on diagnosis.

Breaking the fall

I’m particularly intrigued by work presented regarding neuroprogression and neuroprotection in bipolar disorder. There are obvious benefits to developing strategies to protect people from recurrent mood episodes after a single episode of mania.

Coupling these strategies to a biomarker-based measure of neuroprogression, offering a quantitative way to track the success of an approach, can only make these benefits even greater.

Preserving the past, protecting the future

Alongside unexpected topics sit some subjects whose importance almost ensures them a presence at EPA (and perhaps every other congress this year). The first of these is cognitive remediation – approaches to treating the neurodeterioration endemic to bipolar patients suffering multiple episodes. If successful, preserving neurocognitive ability and social functioning would be a huge step towards lessening the burden of bipolar for those patients most affected by their condition.

Another prime topic is clinical staging, a technique widely used in other disease areas but still gaining a toehold in bipolar disorder. The formation of agreed disease stages, based on range and severity of symptoms, offers a framework to organise the collection of best practice around and should contribute to better treatment selection for patients.

It’s an area where my colleague Professor Vieta is doing exciting work, offering great potential to clarify which treatments or combinations are best suited to each patient subtype.

A deeper diagnosis

For me, tailored medicine is a priority in bipolar disorder and it’s central to my own work on predominant polarity in patient characterisation.

Recent changes to the DSM-5 guidelines have helped us define patient subtypes in bipolar disorder in terms of current episode (for example, ‘with or without mixed features’). What is lacking is a historical perspective – how might a patient’s mix of symptoms change over time?

For example, under the current system, the case of a major depressive episode with mixed features, but without a previous history of a manic or hypomanic episode, will receive a diagnosis of ‘major depressive disorder, single episode’, potentially discouraging the use of valuable adjuncts such as mood stabilisers.

Broadening perspectives

Shifting the criteria for predominant polarity from the number of episodes of a given polarity to the amount of time spent hypomanic or depressed may give a more accurate definition of state. This, in turn, will hopefully guide the selection of appropriate treatment.

Taking this ‘symptomatic history’ approach even further, I am also investigating whether age at onset and duration of untreated disease are predictive of disease trajectory and response to treatment.

These issues will be the focus of my work in the year to come but, with the breadth of research on show at EPA, it’s clear they’re just one of a number of exciting avenues for 2015.