Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

Kupka, Ralph; Duffy, Anne; Scott, Jan; Almeida, Jorge; Balanzá‐Martínez, Vicent; Birmaher, Boris; Bond, David J.; Brietzke, Elisa; Chendo, Inês; Frey, Benício N.; Grande, Iría; Hafeman, Danella; Hájek, Tomáš; Hillegers, Manon H. J.; Kauer-Sant’Anna, Márcia; Mansur, Rodrigo B.; Markt, Afra van der; Post, Robert M.; Tohen, Mauricio; Tremain, Hailey; Vázquez, Gustavo; Vieta, Eduard; Yatham, Lakshmi N.; Berk, Michael; Alda, Martin; Kapczinski, Flávio

doi:10.1111/bdi.13105

Cited by 38 publications

(44 citation statements)

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“…Berk et al 27 exploit a more hopeful approach by stating clinical staging to be useful on the basis of careful exploration of the current level of evidence on staging, suggesting forthcoming directions for further studies. The ISBD staging task force recently published a paper 28 to standardize the nomenclature on clinical staging of BD, in order to facilitate future research.…”

Section: Introductionmentioning

confidence: 99%

Clinical profiles of subsequent stages in bipolar disorder: Results from the Dutch Bipolar Cohort

et al. 2021

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Introduction The manifestation of bipolar disorder (BD) is hypothesized to be determined by clinical characteristics such as familial loading, childhood abuse, age at onset, illness duration, comorbid psychiatric disorders, addiction, treatment resistance, and premorbid cognitive functioning. Which of these are associated with a more severe course and worse outcome is currently unknown. Our objective is to find a combination of clinical characteristics associated with advancement to subsequent stages in two clinical staging models for BD. Methods Using cross‐sectional data from the Dutch Bipolar Cohort, staging was applied to determine the progression of bipolar‐I‐disorder (BD‐I; N = 1396). Model A is primarily defined by recurrence of mood episodes, ranging from prodromal to chronicity. Model B is defined by level of inter‐episodic functioning, ranging from prodromal to inability to function autonomously. For both models, ordinal logistic regression was conducted to test which clinical characteristics are associated with subsequent stages. Results For model A, familial loading, childhood abuse, earlier onset, longer illness duration, psychiatric comorbidity, and treatment resistance were all predictors for a higher stage in contrast to addiction and cognitive functioning. For model B, childhood abuse, psychiatric comorbidity, cognitive functioning, and treatment resistance were predictors for a more severe stage, whereas age at onset, illness duration, and addiction were not. Discussion/conclusions Differences in clinical characteristics across stages support the construct validity of both staging models. Characteristics associated with a higher stage largely overlapped across both models. This study is a first step toward determining different clinical profiles, with a corresponding course and outcome.

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Section: Introductionmentioning

confidence: 99%

Clinical profiles of subsequent stages in bipolar disorder: Results from the Dutch Bipolar Cohort

et al. 2021

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“…Still, given the lack of knowledge of underlying pathophysiology, studies of bipolar illness progression, and hence staging models, for the time being, have not gone beyond the current concept of bipolar disorder, although transdiagnostic models have been proposed. Such transdiagnostic staging models do not assume, as Griesinger hypothesized, that all major psychiatric disorders are in the end the same, but that illness progression may follow similar pathways 1 . For bipolar disorder, there are currently at least three distinct clinical staging models approaching illness progression from a different angle 1 .…”

Section: Illness Progression and Staging: Then And Nowmentioning

confidence: 99%

“…Nonetheless, staging the illness evolution in psychiatry is still under development. 1 Emil Kraepelin, though not an advocate of staging, did see manic-depressive insanity as incorporating several distinctive clinical pictures and represented this concept in graphs. We revisited these graphic representations of typical cases and further explored his and his contemporaries' views of illness progression in the light of current staging models.…”

Section: A Historical Perspective On Illness Progression In Bipolar D...mentioning

confidence: 99%

“…The concept of illness progression (or illness evolution) hypothesizes that changes in the clinical presentation over the long‐term course of the disorder reflect changes in the underlying brain pathophysiology. As in somatic medicine, staging models can be based on symptoms and course (clinical staging) or on underlying pathology (pathological staging), which ideally complement each other 1 . Wilhelm Griesinger (1817–1868) already introduced the staging concept into psychiatry around 1845 3 .…”

Section: Illness Progression and Staging: Then And Nowmentioning

confidence: 99%

“…In Kraepelin's model, psychiatric illnesses were distinguished by their changing clinical picture, and within manic-depressive psychosis, there were many different trajectories over time, including the transition from depression to bipolar disorder, and progression toward chronicity, but always remaining within the boundaries of mood disorder. Still, he stressed the large heterogeneity in course and prognosis, as illustrated by his graphics.Griesinger assumed that illness progression reflected underlying brain pathophysiology; he thus anticipated a pathological staging model 1,3. Kraepelin's monograph 2 focused on clinical presentation and diagnosis (180 pages), but less on causes (20 pages, descriptive rather than explanatory) and treatment (5 pages).…”

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A historical perspective on illness progression in bipolar disorder

et al. 2022

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Dialectical Behavior Therapy for Adolescents With Bipolar Disorder

Goldstein,

Merranko,

Rode

et al. 2024

JAMA Psychiatry

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ImportanceEarly-onset bipolar disorder conveys substantial risk for suicide. No psychosocial intervention for this population expressly targets suicidal behavior.ObjectiveTo determine whether dialectical behavior therapy (DBT) for adolescents with bipolar spectrum disorder is more effective than standard of care (SOC) psychotherapy in decreasing suicide attempts over 1 year.Design, Settings, and ParticipantsAdolescents aged 12 to 18 years diagnosed with bipolar spectrum disorder were recruited from a specialty outpatient psychiatric clinic between November 2014 and September 2019. Independent evaluators conducted quarterly assessments over 1 year with participants and parents. Data were analyzed from March 2021 to November 2022.InterventionsParticipants were randomly assigned to 1 year of DBT (36 sessions; n = 47) or SOC psychotherapy (schedule clinically determined; n = 53). All youth received medication management via a flexible algorithm.Main Outcomes and MeasuresPrimary outcomes included suicide attempts over 1 year and mood symptoms and states (depression and hypomania/mania). Secondary analyses included moderation of DBT effects by history of suicide attempt and mediation through emotion dysregulation.ResultsOf 100 included participants, 85 (85%) were female, and the mean (SD) age was 16.1 (1.6) years. Participants were followed up over a mean (SD) of 47 (14) weeks. Both treatment groups demonstrated significant and similar improvement in mood symptoms and episodes over 1 year (standardized depression rating scale slope, −0.17; 95% CI, −0.31 to −0.03; standardized mania rating scale slope, −0.24; 95% CI, −0.34 to −0.14). DBT and SOC participants reported similar suicide attempt rates at intake as measured on the Adolescent Longitudinal Follow-Up Evaluation (ALIFE; mean [SD] attempts, 2.0 [4.5] vs 1.8 [3.9], respectively; P = .80). DBT participants reported slightly more suicide attempts at intake as measured on the Columbia-Suicide Severity Rating Scale Pediatric Version (C-SSRS; mean [SD] attempts, 1.4 [3.6] vs 0.6 [0.9]; P = .02). DBT participants reported significantly fewer suicide attempts over follow-up compared with SOC participants via the ALIFE (mean [SD] attempts per follow-up period, 0.2 [0.4] vs 1.1 [4.3], controlling for baseline attempts: P = .03) and the C-SSRS (mean [SD] attempts per follow-up period, 0.04 [0.2] vs 0.10 [0.3], controlling for baseline attempts; P = .03). DBT was significantly more effective than SOC psychotherapy at decreasing suicide attempts over 1 year (ALIFE: incidence rate ratio [IRR], 0.32; 95% CI, 0.11-0.96; C-SSRS: IRR, 0.13; 95% CI, 0.02-0.78). Decreased rate of suicide attempts in DBT was moderated by presence of lifetime history of suicide attempt and time (IRR, 0.23; 95% CI, 0.13-0.44) and mediated by improvement in emotion dysregulation (IRR, 0.61; 95% CI, 0.42-0.89), particularly for those with high baseline emotion dysregulation (standardized β, −0.59; 95% CI, −0.92 to −0.26).Conclusions and RelevanceIn this randomized clinical trial, DBT demonstrated efficacy in decreasing suicide attempts among the high-risk population of adolescents with bipolar spectrum disorder.Trial RegistrationClinicalTrials.gov Identifier: NCT02003690

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Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 38 publications

References 173 publications

Clinical profiles of subsequent stages in bipolar disorder: Results from the Dutch Bipolar Cohort

Clinical profiles of subsequent stages in bipolar disorder: Results from the Dutch Bipolar Cohort

A historical perspective on illness progression in bipolar disorder

Dialectical Behavior Therapy for Adolescents With Bipolar Disorder

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