A clinical staging model for bipolar disorder: longitudinal approach

Abstract

Bipolar disorder (BD) has been identified as a life-course illness with different clinical manifestations from an at-risk to a late stage, supporting the assumption that it would benefit from a staging model. In a previous study, we used a clustering approach to stratify 224 patients with a diagnosis of BD into five clusters based on clinical characteristics, functioning, cognition, general health, and health-related quality of life. This study was design to test the construct validity of our previously developed k-means clustering model and to confirm its longitudinal validity over a span of 3 years. Of the 224 patients included at baseline who were used to develop our model, 129 (57.6%) reached the 3-year follow-up. All life domains except mental health-related quality of life (QoL) showed significant worsening in stages (p < 0.001), suggesting construct validity. Furthermore, as patients progressed through stages, functional decline (p < 0.001) and more complex treatment patterns (p = 0.002) were observed. As expected, at 3 years, the majority of patients remained at the same stage (49.6%), or progressed (20.9%) or regressed (23.3%) one stage. Furthermore, 85% of patients who stayed euthymic during that period remained at the same stage or regressed to previous stages, supporting its longitudinal validity. For that reason, this study provides evidence of the construct and longitudinal validity of an empirically developed, comprehensive staging model for patients with BD. Thus, it may help clinicians and researchers to better understand the disorder and, at the same time, to design more accurate and personalized treatment plans.

Specific metabolic syndrome components predict cognition and social functioning in people with type 2 diabetes mellitus and severe mental disorders

“…Thus, early detection of changes in those MetS components offers an opportunity to promote healthy lifestyle behaviors in individuals with SMI and T2DM, which in turn may reduce the risk of developing cardiometabolic complications. In this respect, we emphasize the importance of including MetS components as promising illness diagnostic markers for individuals with SMI and T2DM 18 . Furthermore, our findings converge with the current therapeutic strategy of increasing physical activity and improving the quality of the dietary patterns to address MetS.…”

“…16 Moreover, individuals with SMI and MetS have a more severe condition, a worse response to pharmacological treatments and a worse prognosis than individuals without MetS. 17,18 On the other hand, recent studies have reported that MetS is significantly associated with cognitive impairment in individuals with SMI, which could in turn contribute to a decline in social functioning. 19,20 Other studies have suggested that BP, HDL, and TG are important predictors of cognition in individuals with SMI, whereas AO is one of the predictors of cognitive impairment and quality of life.…”

The Heterogeneity of Longitudinal Cognitive Decline in Euthymic Bipolar I Disorder With Clinical Characteristics and Functional Outcomes

“…Such longitudinal cognitive profiles can potentially facilitate further genetic and biological studies and help clinicians develop more effective and personalized intervention strategies ( 46 , 47 ). As we had suggested, the heterogeneity of the cognitive trajectory conformed to the progress of illness in clinical manifestation staging models including cognitive deterioration ( 48 ). Our findings revealed that cognitive decline varies from one patient to another, with decline in certain patients while others remain stable.…”

<p>Ketamine in Bipolar Disorder: A Review</p>

“… 99 These stages include cognitive deterioration and functional decline, changes in inflammatory and neuroanatomical biomarkers, lowered response to treatment, and a worsened self-reported quality of life, all of which have been linked to disorder progression. 100 To date, there has been a lack of staging models based on psychopathology. 101 Kapczinski et al 102 , 103 suggested a model that accounted for functioning, cognitive performance, and blood biomarkers.…”