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European Psychiatry
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mardi 24 avril 2012
Doi : 10.1016/j.eurpsy.2011.11.007
Received : 1 July 2011 ;  accepted : 11 November 2011
The clinical implications of cognitive impairment and allostatic load in bipolar disorder
 

E. Vieta a, ⁎ , D. Popovic a, b, A.R. Rosa a, c, B. Solé a, I. Grande a, B.N. Frey d, A. Martinez-Aran a, J. Sanchez-Moreno a, V. Balanzá-Martínez e, R. Tabarés-Seisdedos e, F. Kapczinski c
a Bipolar Disorders Program, Clinical Institute of Neuroscience, University Clinic Hospital of Barcelona, IDIBAPS, CIBERSAM, Villarroel 170, 08036 Barcelona, Spain 
b Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Ospedale Santa Chiara, Via Roma 67, 56100 Pisa, Italy 
c Bipolar Disorders Program and INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, UFRGS, Ramiro Barcelos, 2350 CEP 90035-003, Porto Alegre, RS, Brazil 
d Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada H3A 2B4 and Montreal Neurological Institute, McGill University, Montreal, QC, Canada 
e Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Blasco-Ibáñez 17, 46010 Valencia, Spain 

Corresponding author. Tel.: +34 93 2275401; fax: +34 932275795.
Abstract
Background

Allostatic load (AL) relates to the neural and bodily “wear and tear” that emerge in the context of chronic stress. This paper aims to provide clinicians with a comprehensive overview of the role of AL in patophysiology of bipolar disorder (BD) and its practical implications.

Methods

PubMed searches were conducted on English-language articles published from 1970 to June 2011 using the search terms allostatic load, oxidative stress, staging, and bipolar disorder cross-referenced with cognitive impairment, comorbidity, mediators, prevention.

Results

Progressive neural and physical dysfunction consequent to mood episodes in BD can be construed as a cumulative state of AL. The concept of AL can help to reconcile cognitive impairment and increased rates of clinical comorbidities that occur over the course of cumulative BD episodes.

Conclusions

Data on transduction of psychosocial stress into the neurobiology of mood episodes converges to the concept of AL. Mood episodes prevention would not only alleviate emotional suffering, but also arrest the cycle of AL, cognitive decline, physical morbidities and, eventually, related mortality. These objectives can be achieved by focusing on effective prophylaxis from the first stages of the disorder, providing mood-stabilizing agents and standardized psychoeducation and, potentially, addressing cognitive deficits by the means of specific medication and neuropsychological interventions.


Keywords : Bipolar disorder, Mania, Depression, Cognitive impairment, Prophylaxis, Allostatic load


OutlineMasquer le plan
Introduction
Allostatic load and its mediators
Cognitive impairment in bipolar disorder
Staging
Prevention and treatment of cognitive and allostatic load correlates in bipolar disorder  (+)
Limitations and conclusions
Future directions


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