Toward a Comprehensive Clinical Staging Model for Bipolar Disorder: Integrating the Evidence

Abstract

Objectives: To describe key findings relating to the natural history and heterogeneity of bipolar disorder (BD) relevant to the development of a unitary clinical staging model. Currently proposed staging models are briefly discussed, highlighting complementary findings, and a comprehensive staging model of BD is proposed integrating the relevant evidence.Method: A selective review of key published findings addressing the natural history, heterogeneity, and clinical staging models of BD are discussed. Results:The concept of BD has broadened, resulting in an increased spectrum of disorders subsumed under this diagnostic category. Different staging models for BD have been proposed based on the early psychosis literature, studies of patients with established BD, and prospective studies of the offspring of parents with BD. The overarching finding is that there are identifiable sequential clinical phases in the development of BD that differ in important ways between classical episodic and psychotic spectrum subtypes. In addition, in the context of familial risk, early risk syndromes add important predictive value and inform the staging model for BD. Conclusions:A comprehensive clinical staging model of BD can be derived from the available evidence and should consider the natural history of BD and the heterogeneity of subtypes. This model will advance both early intervention efforts and neurobiological research. W W WVers un modèle complet de staification clinique du trouble bipolaire : intégrant l'évidence Objectifs : Décrire les principaux résultats concernant l'histoire naturelle et l'hétérogénéité du trouble bipolaire (TB) qui se rapportent à l'élaboration d'un modèle unitaire de stades cliniques. Les modèles de staification présentement proposés sont brièvement présentés, de même que les résultats complémentaires, et un modèle complet de staification du TB est proposé qui intègre les données probantes pertinentes.Méthode : Est présentée une revue sélective des principaux résultats publiés sur l'histoire naturelle, l'hétérogénéité, et les modèles de staification clinique du TB.Résultats : Le concept du TB s'est élargi, ce qui a donné un spectre accru de troubles classés dans cette catégorie diagnostique. Différents modèles de staification du TB ont été proposés d'après la littérature sur la psychose précoce, les études de patients souffrant d'un TB établi, et les études prospectives des enfants de parents souffrant de TB. Le résultat déterminant est qu'il y a des phases cliniques séquentielles identifiables dans le développement du TB qui diffèrent de manière importante entre les sous-types épisodiques classiques et ceux du spectre psychotique. En outre, dans le contexte du risque familial, les syndromes de risque précoce ajoutent une valeur prédictive importante et éclairent le modèle de stadification du TB.Conclusions : Un modèle complet de stadification clinique du TB peut être déduit des données probantes disponibles et devrait tenir compte de l'histoire naturelle du TB et de l'hétérogénéité des sous-types. Ce ...

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