[The staging model (or evolutionary stages) applied to bipolar disorder]

Area of Science:

• Psychiatry
• Clinical Psychology
• Neuroscience

Background:

• Clinical staging is crucial for understanding mental disorder trajectories and identifying at-risk individuals.
• Its application in early intervention for psychoses is established.
• Broadening clinical staging to affective disorders, particularly bipolar disorder, presents challenges due to complex presentations.

Purpose of the Study:

• To explore the complexities of applying clinical staging to affective disorders, specifically bipolar disorder.
• To highlight the need for improved understanding of risk factors, biomarkers, and endophenotypes for bipolar disorder onset and progression.
• To investigate how clinical staging can enhance knowledge of pathophysiological correlates and reduce reliance on symptom-based assessments.

Main Methods:

• Literature review and conceptual analysis of clinical staging paradigms.
• Examination of challenges in staging affective disorders, including bipolar disorder's prodromal and manic phases.
• Discussion of the potential benefits of improved understanding of risk factors and biomarkers.

Main Results:

• Clinical staging is effective for psychoses but faces difficulties when applied to the varied presentations of bipolar disorder.
• Identifying the precise stage for depressive episodes preceding mania and subthreshold manic syndromes remains complex.
• A deeper understanding of risk factors and biomarkers is needed to refine staging models for bipolar disorder.

Conclusions:

• Clinical staging holds promise for advancing the understanding of bipolar disorder progression.
• Further research into risk factors, biomarkers, and endophenotypes is essential for developing effective staging models.
• Clinical staging may help shift focus from cross-sectional symptom assessment to understanding underlying pathophysiology.