Testing a clinical staging model for bipolar disorder using longitudinal life chart data

Abstract

Objective Bipolar disorder has a wide range of clinical manifestations which may progress over time. The aim of this study was to test the applicability of a clinical staging model for bipolar disorder and to gain insight into the nature of the variables influencing progression through consecutive stages. Methods Using retrospectively reported longitudinal life chart data of 99 subjects from the Stanley Foundation Bipolar Network Naturalistic Follow‐up Study, the occurrence, duration and timely sequence of stages 2‐4 were determined per month. A multi‐state model was used to calculate progression rates and identify determinants of illness progression. Stages 0, 1 and several other variables were added to the multi‐state model to determine their influence on the progression rates. Results Five years after onset of BD (stage 2), 72% reached stage 3 (recurrent episodes) and 21% had reached stage 4 (continuous episodes), of whom 8% recovered back to stage 3. The progression from stage 2 to 3 was increased by a biphasic onset for both the depression‐mania and the mania‐depression course and by male sex. Conclusions Staging is a useful model to determine illness progression in longitudinal life chart data. Variables influencing transition rates were successfully identified.

Exploring the clinical utility of two staging models for bipolar disorder

“…The model is fueled by the neuroprogression hypothesis that every mood episode is toxic to the brain . We previously applied this model to patients in order to evaluate the stage progression over the course of the first 5 years after the diagnosis of BD . Frank et al applied this model to subjects with BD to assess genetic and neuroimaging markers for each stage, after which progressive changes were found.…”

“…Both models take a complementary perspective on illness progression, and are studied separately, but not in relationship to each other. External criteria have only been tested for each model separately.…”

“…16 We previously applied this model to patients in order to evaluate the stage progression over the course of the first 5 years after the diagnosis of BD. 17 Frank et al 18 applied this model to subjects with BD to assess genetic and neuroimaging markers for each stage, after which progressive changes were found. Kapczinski et al 19 proposed an alternative staging model In this study, we have investigated both models next to each other using data from the Dutch Bipolar Cohort.…”

The need for prospective longitudinal cohort studies on the clinical staging models in bipolar disorder—A commentary to the study by van der Markt et al, 2018

“…Thus, it is imperative to describe and understand these changes during the longitudinal course of illness. The study by van der Markt et al is the first attempt to assess the clinical applicability of a staging model within bipolar disorder . Using retrospective data form the Stanley Foundation Bipolar Network, five years after onset of bipolar disorder (stage 2), 72% reached stage 3 (recurrent episodes) and 21% had reached stage 4 (continuous episodes), of whom 8% recovered back to stage 3.…”

Clinical staging model in bipolar disorder: A few considerations

“…Although there have been attempts at staging psychiatric disorders, there remains a void of universally accepted and implemented staging mechanisms and criteria for these illnesses. Researchers like Markt et al have attempted to address the gap by providing staging methods using patient data. Their findings generate interest and stimulate certain considerations for the future.…”