Episode one

Professor Leonardo Tondo from the McLean Hospital Harvard Medical School began the session with a dissection of the clinical course of bipolar disorder, honing in on the first episode, and what healthcare professionals can learn about a patient’s prognosis from this pivotal event.

Prof Tondo emphasised the predictive nature of the onset of bipolar disorder, presenting data linking a number of first-episode symptoms to specific diagnoses and paths of disease progression. For example, a study by Baldessarini et al. showed that mania, psychosis or mixed-state symptoms were common in patients eventually diagnosed with bipolar I disorder.

Variety is the spice of life

A recurring theme of Prof Tondo’s talk was the extreme degree of variability in the clinical manifestations of bipolar disorder. However, careful assessment at this early, first-episode stage can not only assist with accurate diagnosis and treatment, but also help patients to better deal with their condition, by ensuring that they are more informed.

A change is coming

Professor Flavio Kapczinski followed Prof Tondo with a revealing analysis of the impact of bipolar disorder on patients’ biochemistry, echoing some of the hot research on neurocognitive impairment in mood disorders that was presented by Prof Michael Berk on day two.

The Professor shed further light on the idea that after the first episode, many patients achieve good syndromal recovery, but functional changes in biochemical pathways of the brain continue to occur even after remission.

Inflammation station

Prof Kapczinski’s research suggested that bipolar disorder can have far-reaching effects, influencing everything from how a patient feels to the structure of the DNA in their cells. He described bipolar as an inflammatory, toxic process involving the activation of immune pathways and the alteration of the brain at the most basic, genetic level.

With the results of recent studies, Prof Kapczinski made the important point that patients who are early on in their disease course respond much better to both pharmacological therapy and psychoeducation (involving the patient’s family), compared with patients who were further down the line. Thus, plotting a disease progression is a relevant and useful tool in treating bipolar disorder.

You are what you eat

Vincent Balanza-Martinez, Associate Professor of Psychiatry in Valencia, wrapped up what was a riveting symposium with his discussion on the benefits of nutritional intervention in serious mood disorders.

Nutritional intervention can take many forms, from general information about healthy diet and exercise, to structured and closely monitored patient programs.

During the closing questions, the professor emphasised his belief that for the best chance of working, nutritional measures need to be delivered as manageable and specific guidance, stating “I think it’s useless to tell our patients ‘go out and do some exercise’. What does it mean? We need to start dosing [nutritional] interventions”.

Minds at work

Over the course of WPA, much has been made of increased focus on concurrent mania and depressive symptoms, with the ‘mixed’ specifier. But it wasn’t until this symposium that the true implications of this were really brought home to me.

If, as the evidence from the presentations suggests, bipolar symptoms cause fundamental changes in the patient’s brain, then the longer we delay treatment for the depressive as well as the manic symptoms, the more pronounced these changes might be.

Sometimes, in the rush of the fascinating, high-level science that this correspondent has heard at WPA, the human impact of these conditions can slip away. It takes a symposium like this one to really show the profound impact of psychiatry can have on the future of our patients.

Continue the conversation on Twitter at #wpa2014