RETRACTED ARTICLE: Staging in Neuropsychiatry: A Heuristic Model for Understanding, Prevention and Treatment

Abstract

The main mental disorders which develop and persist through adult life typically emerge during the critical developmental phase of adolescence and early adulthood, and are frequently associated with considerable associated distress and functional decline. Our current diagnostic system lacks validity and therapeutic utility, particularly for the early stages of these mental disorders, when symptoms are still evolving and may have not yet stabilised sufficiently to fit familiar or traditional syndromal criteria. Furthermore, there is often difficulty in distinguishing transient developmental or normative changes from the early symptoms of persistent and disabling mental illness. These factors point to the need for reform of our current diagnostic systems. The clinical staging model seeks to define the extent of progression of a disorder at a particular point in time and aims to differentiate early, milder clinical phenomena from those that accompany illness progression and chronicity. The staging framework allows clinicians to select treatments relevant to earlier stages of an illness, and to evaluate their effectiveness in preventing progression and producing remission or return to milder or earlier stages of disorder. For staging to be a valid approach, interventions in the early stages need to shown to be not only more effective but also safer than treatments delivered later in the course of illness. Staging may also allow a more efficient integration of our rapidly expanding knowledge of the biological, social and psychological vulnerability factors involved in development of mental illness into what may ultimately resemble a clinicopathological staging model.

Negative Symptoms and Executive Function in Schizophrenia: Does Their Relationship Change with Illness Duration?

“…In this way, studies with patients in early stages of schizophrenia could have difficulties in finding correlations between negative symptoms and executive function if the variable considered was WCST perseverative errors, as is often the case. Staging is currently regarded as a systematic conceptual instrument which facilitates a better understanding, diagnosis, prognosis and treatment in psychotic disorders [68,69] and helps develop clinicopathological models of mental illness [66]. Although staging involves pathophysiological and clinical changes as the illness progresses, and not just a progression in time, illness duration is a related concept which could be considered as an approximation to stage of illness where more precise measures of illness progression are still lacking.…”

“…Rather than as a static disorder, schizophrenia has been regarded as an illness which progresses with time. Recently, McGorry [65 ]and other authors have proposed a staging model to conceptualize schizophrenia similar to that used in other medical disorders, given that during its course there are clinical and underlying pathophysiological differences at different time points across the duration of the illness [65,66,67,68,69]. …”

Staging of Mental Disorders: Systematic Review

“…They developed staging methods for unipolar depression, bipolar disorder, panic disorder and schizophrenia based on the longitudinal development of a psychiatric disorder, ranging from the prodromal to the residual and chronic forms. In the past decade there have been further developments in the literature [16,17,18,19,20,21,22,23,24]. Such contributions have stressed the role of staging to improve the clinician’s capacity to select treatments relevant to earlier stages, assuming that these interventions can be more effective and less harmful than treatments delivered later in the course of the illness and that they might help prevent progression to more advanced stages or promote regression to an earlier stage.…”

The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines

“…The field in medicine where staging is most successful and enjoys great importance is that of clinical oncology. Since 1993 there were many attempts to arrive at a staging model for psychiatry (Fava and Kellner, 1993; Yung and McGorry, 1996, 2007; McGorry et al, 2006, 2007, 2010; McGorry, 2007, 2010b; Vieta et al, 2011; Cosci and Fava, 2013). The concept of staging if and when applied has a number of implications.…”