Abstract
This book provides a very interesting insight into bipolar disorder (BD). It begins by describing something of the historical context of BD and then goes on to discuss sensitization and inflammation, with a stronger focus on the latter, as models of disease progression and concepts for staging. The book is a result of the Task Force on Staging of the International Society of Bipolar Disorders (ISBD). Michael Berck and Flavio Kapczinski were both pioneers in the staging approach to BD, inspired by staging studies in schizophrenia. The authors support this new methodology for the evaluation and monitoring of BD patients, based on Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria. Interestingly, it uses the same staging principle from other areas of medicine, such as oncology and cardiology. This brand new vision for psychiatric disorders is well explored through the book.
Most of the chapters are self-contained but nevertheless thematically connected to each other in a didactic sequence. The work also pays special attention to research and potential clinical issues, such as cognition, neuroprogression, and neuroprotection, giving the idea that patients with BD have problems with development and neuropsychological progress, BD being considered a neurodevelopmental disorder. It discusses BD allostatic load, having cortisol as one of its mediators, and the concept of neurotrophins, oxidative stress, and cellular resilience mechanisms, bringing neurochemistry and neurobiology to the psychopathology of psychiatric disorders. This is in line with a global trend of bringing these concepts together, distancing psychiatry from empiricism and locating it more within neuroscience.
Interestingly, it also addresses BD patient functionality, describing deficits and targets for the functional recovery of the patient. It raises further concerns such as the use of biomarkers to assess disease progression, as performed in many other areas. Such an approach regards BD as a multifactorial disorder, in which several variables could play a role and explain the complex clinical features.
The book deals in depth with the neurobiological features of BD but does not neglect societal aspects with both being discussed in some detail within the text. First, they try to incorporate social cognition into their staging approach. The authors correctly state that during manic episodes, individuals may make incorrect vocational, economic, and social decisions due to biased perception and underestimating the feelings of others. These are among the most important factors in the burden of affective disorders. The authors point to social cognition paradigms as one of the most promising ways to address the physiological bases of these symptoms. Later in the book, there is an informative chapter on childhood adversities and BD progress which identifies childhood adversities as one of the most important etiological factors in BD, as in any other psychiatric disease. From the social etiology and consequent management point of view, this is the most insightful chapter, and here the reader will find descriptions of the clinical outcomes associated with this complex psychosocial variable, which includes emotional, physical, and sexual abuse, as well as emotional and physical neglect.
The authors present their approach to BD in an easy and accessible language, even for non-psychiatrists. The book, which also contains several useful tables, charts, and figures, could be used on undergraduate courses, although not primarily intended for such a purpose. However, it possesses the necessary depth to be considered innovative in regard to certain of the concepts it touches on.