[Staging of bipolar affective illness]

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Medicine

Context:

• Bipolar disorder (BD) staging models conceptualize illness progression from prodromal to treatment-refractory states.
• Four distinct staging models for BD have been proposed, each offering a unique perspective on disease development and severity.

Purpose:

• To review and compare four proposed staging models for bipolar disorder (BD).
• To highlight the clinical implications of staging, particularly the necessity of early intervention and stage-appropriate treatment.

Summary:

• Robert Post's model emphasizes kindling and neurosensitization, where stressors trigger initial episodes leading to persistent neural changes and increased relapse vulnerability.
• Anne Duffy's model, based on high-risk offspring, outlines early developmental stages from childhood, including non-mood and minor mood disorders, and acute episodes.
• Michael Berk's model aligns with therapeutic algorithms, classifying stages by clinical features, prognosis, and treatment response, identifying high-risk individuals for early intervention.
• Flavio Kapczinski's model utilizes allostatic load, assessing biomarker and cognitive function changes between and during episodes.

Impact:

• Staging models underscore the importance of tailoring treatments to the specific stage of bipolar disorder.
• Early intervention, targeting the first episode, is critical to prevent neuroanatomical, neuropsychological, clinical, and functional consequences of BD.