Staging model raises fundamental questions about the nature of bipolar disorder

Alda, Martin; Kapczinski, Flávio

doi:10.1503/jpn.160151

Cited by 12 publications

(15 citation statements)

References 21 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overall, the staging models describe three broad clinical stages: (I) individuals at increased risk for developing BD due to family history as well as certain subsyndromal symptoms predictive of conversion into full‐blown BD; (II) patients with fewer episodes and optimal functioning in the interepisodic periods, and (III) patients with recurrent episodes as well as decline in functioning and cognition 31. So far, the heterogeneity intrinsic to BD has prevented the clinical use of staging systems 32. In addition, the field of staging is in its infancy and the ability of staging systems to guide prognosis and treatment is still to be determined.…”

Section: Foundations Of Managementmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

Self Cite

View full text Add to dashboard Cite

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

show abstract

Section: Foundations Of Managementmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…It is recognized that heterogeneity is a major issue among patients with bipolar disorder and the assumption that patients move through stages in linear fashion is not supported by data [2]. However, there is a very productive debate in the area of staging in bipolar disorder that will surely yield benefits for patients and the field as a whole [32][33][34]. In addition, retrospective studies present important limitations to assess number of episodes.…”

Section: Discussionmentioning

confidence: 99%

Should bipolar disorder treatment be modified depending on staging?

Passos

Kapczinski

2016

Expert Review of Neurotherapeutics

View full text Add to dashboard Cite

“…We have been involved in some of the longitudinal highrisk studies of young people at risk for bipolar disorder. [1][2][3] These studies, among others, described early stages of the illness and their comorbidities 4 as well as neuropsychological function ing 5 and structural brain findings. 6 Based on these studies as well as on observations of other authors, we be lieve that the point of heterogeneity of bipolar disorder and the need to sepa rate it from the concept of uniformly progressing illness are equally applica ble in the early stages as in the latter ones.…”

Section: Author Responsementioning

confidence: 99%

“…In an interesting editorial in the Sep tember issue, Alda and Kapczinski ex plore the clinical staging model as ap plied to bipolar disorder, 1 consider some of the strengths and weaknesses of this approach and go on to comment on the predictions suggested by Scott and colleagues. 2 Although the editorial rightly points out some of the limita tions of current staging models, many of the authors' conclusions draw heavi ly on 2 ideas that are not core to most staging models, namely that staging is largely about established disorder and that disease progression is predom inantly described by severity, with co morbidities treated as separate entities.…”

mentioning

confidence: 99%