The potential utility of a staging model as a course specifier: A bipolar disorder perspective

The Dutch Bipolar Offspring Study: 12-Year Follow-Up

“…On the other hand, the long delay between the first unipolar mood episode and the onset of the first manic or hypomanic episode as found in this study may also suggest that the recurrent unipolar mood disorders in our cohort rather reflect the early stages of future bipolar disorder. These findings are in concordance with findings from a prospective study in adults by Angst et al (33), and this possibility is also proposed in several theoretical staging models (34,35). Apart from the meaning of recurrent depression in the concept of bipolar disorder, clinically it is important to realize that the depressive course in bipolar spectrum disorders is especially associated with a high burden of illness (36).…”

Staging model raises fundamental questions about the nature of bipolar disorder

“…3 The first full mood episodes of mania and depression are usually followed by remissions, but later on symptoms persist between the episodes, and this more chronic course is often associated with structural and func tional brain impairment. 4,5 The most common argument supporting the staging model for bipolar disorder is the perception that longer duration of illness leads to more pronounced clinical and pathological changes. These include treatment refractoriness, structural brain changes with a loss of grey matter, cortical thinning and ventricular enlargement, neuropathological changes in postmortem studies (reduced glial density) as well as neuro psychological deficits.…”

“…These include treatment refractoriness, structural brain changes with a loss of grey matter, cortical thinning and ventricular enlargement, neuropathological changes in postmortem studies (reduced glial density) as well as neuro psychological deficits. 4,5 Clinical and pathophysiological heterogeneity represents an alternative or perhaps complementary concept to uniform progression of bipolar disorder from early to late stages. When heterogeneous groups of patients are examined cross sectionally they may appear to comprise individuals at dif ferent disease stages.…”

The concept of staging in bipolar disorder: the role of BDNF and TNF-alpha as biomarkers

“…Recent research findings in the field could lead to a more informative classification, with course being a potential specifier, analogous to staging methods used in medical illness, in addition to the current axial classification (2). In this context, the initiative to develop a suitable staging method for BD is receiving increasing attention (3).…”

“…These deficits may better indicate illness severity when they persist during remission of mood symptoms. Two staging models have been proposed (1,3), the first emphasising the early stages of the disorder, and by implication, the potential for early intervention, and the second staging model emphasises the inter-episodic period as the most adequate window to perform staging assessment. Moderate impairment in functioning due to enduring sub-syndromal BD symptoms which are not resolved with therapy and/or clinically relevant cognitive and functioning; Stage 4: Patients unable to take care of themselves without assistance of family or day-care centres due to unremitting symptoms and/or severe cognitive impairment owing to the disorder.…”