View article

One of the drivers of Malhi et al’s1 pessimistic perspective on early intervention for those meeting criteria for bipolar disorder (BD) is the Hippocratic principle of “first do no harm”. Paradoxically, if their overly cautious prescription were followed, then more harm would likely occur through continuing neglect of young people with a substantial, immediate need for care. 2 Their conclusions derive from two familiar misunderstandings of the clinical staging model. Firstly, they have restricted their gaze within the silo of BD in considering how early intervention could be offered. Clinical staging in psychiatry uses a transdiagnostic framework, acknowledging the heterogeneity and overlap of early clinical phenotypes. Secondly, they misrepresent staging as requiring inevitable progression, rather than each stage connoting only a risk for progression with remission possible at any stage.

The authors observe that the early and …