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Chapter 2 - Clinical Staging and Its Potential to Enhance Mental Health Care

from Section 1 - Conceptual and Strategic Issues

Published online by Cambridge University Press:  08 August 2019

Patrick D. McGorry
Affiliation:
University of Melbourne
Ian B. Hickie
Affiliation:
University of Sydney
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Summary

Over the last two decades application of the clinical staging model in mental health has been advocated to improve diagnosis, intervention, prediction of illness trajectory and, ultimately, outcomes. The model offers a substantive advance for mental health care as it goes beyond traditional fixed categories to incorporate a stepwise continuum to guide much more appropriate treatment planning and prognosis. In this chapter, an overview of this advanced type of clinical staging is provided. With its focus on the continuum of mental illness, and underlying differential trajectories of illness progression that are not well captured by current categorical diagnostic practice, staging addresses the key limitations of traditional diagnostic categorical systems. It proposes that effective, safe and timely stage-specific treatments can be implemented to inhibit and delay illness onset and progression. It also enables biomarkers to be analysed according not only to syndrome but also stage. The model is supported by a number of clinical, longitudinal and neurobiological studies. Whilst clinical staging has clear and immediate potential benefits, further research investigating risk and protective factors and treatment outcomes across different stages and the creation of tools that clinicians can routinely use will determine the ultimate utility and value of the model.

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Chapter
Information
Clinical Staging in Psychiatry
Making Diagnosis Work for Research and Treatment
, pp. 12 - 33
Publisher: Cambridge University Press
Print publication year: 2019

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References

Anttila, V., Bulik-Sullivan, B., Finucane, H. K., Walters, R. K., Bras, J., Duncan, L., … Neale, B. M. (2018). Analysis of shared heritability in common disorders of the brain. Science, 360(6395), eaap8757.Google ScholarPubMed
Banati, R., & Hickie, I. B. (2009). Therapeutic signposts: using biomarkers to guide better treatment of schizophrenia and other psychotic disordersMedical Journal of Australia190(4), S26S32.Google Scholar
Bartholomeusz, C. F., Cropley, V. L., Wannan, C., Di Biase, M., McGorry, P. D., & Pantelis, C. (2017). Structural neuroimaging across early-stage psychosis: aberrations in neurobiological trajectories and implications for the staging modelAustralian and New Zealand Journal of Psychiatry51(5), 455476.Google Scholar
Berk, M., Brnabic, A., Dodd, S., Kelin, K., Tohen, M., Malhi, G. S., … McGorry, P. D. (2011). Does stage of illness impact treatment response in bipolar disorder? Empirical treatment data and their implication for the staging model and early interventionBipolar Disorders13(1), 8798.Google Scholar
Cosci, F., & Fava, G. A. (2013). Staging of mental disorders: systematic reviewPsychotherapy and Psychosomatics82(1), 2034.CrossRefGoogle ScholarPubMed
Cross, S. P., Hermens, D. F., & Hickie, I. B. (2016). Treatment patterns and short‐term outcomes in an early intervention youth mental health serviceEarly Intervention in Psychiatry10(1), 8897.Google Scholar
Cross, S. P., Hermens, D. F., Scott, E. M., Ottavio, A., McGorry, P. D., & Hickie, I. B. (2014). A clinical staging model for early intervention youth mental health services. Psychiatric Services, 65(7), 939943.Google Scholar
Cross, S. P., Scott, J., & Hickie, I. B. (2017). Predicting early transition from sub-syndromal presentations to major mental disorders. British Journal of Psychiatry Open, 3(5), 223227.Google Scholar
Cuthbert, B. N., & Insel, T. R. (2013). Toward the future of psychiatric diagnosis: the seven pillars of RDoCBMC Medicine, 11, 126.CrossRefGoogle ScholarPubMed
Dohm, K., Redlich, R., Zwitserlood, P., & Dannlowski, U. (2017). Trajectories of major depression disorders: a systematic review of longitudinal neuroimaging findingsAustralian and New Zealand Journal of Psychiatry51(5), 441454.Google Scholar
Duffy, A. (2014). Toward a comprehensive clinical staging model for bipolar disorder: integrating the evidenceCanadian Journal of Psychiatry59(12), 659666.Google Scholar
Duffy, A., Malhi, G. S., & Grof, P. (2017). Do the trajectories of bipolar disorder and schizophrenia follow a universal staging model? Canadian Journal of Psychiatry, 62(2), 115122.Google Scholar
Early Psychosis Guidelines Writing Group and EPPIC National Support Program. (2016). Australian clinical guidelines for early psychosis (2nd ed.). Melbourne: Orygen, The National Centre of Excellence in Youth Mental Health.Google Scholar
Fava, G. A., & Kellner, R. (1993). Staging: a neglected dimension in psychiatric classificationActa Psychiatrica Scandinavica, 87(4), 225230.CrossRefGoogle ScholarPubMed
Frank, E., Nimgaonkar, V. L., Phillips, M. L., & Kupfer, D. J. (2015). All the world’s a (clinical) stage: rethinking bipolar disorder from a longitudinal perspectiveMolecular Psychiatry20(1), 2331.CrossRefGoogle ScholarPubMed
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., … Tran, N. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disordersAustralian and New Zealand Journal of Psychiatry50(5), 410472.Google Scholar
Greenberg, G. (2013). The book of woe: the DSM and the unmaking of psychiatry. New York: Blue Rider Press.Google Scholar
Hamilton, B. A., Naismith, S. L., Scott, E. M., Purcell, S., & Hickie, I. B. (2011). Disability is already pronounced in young people with early stages of affective disorders: data from an early intervention serviceJournal of Affective Disorders131(1), 8491.Google Scholar
Hamilton, M. P., Hetrick, S. E., Mihalopoulos, C., Baker, D., Browne, V., Chanen, A. M., … McGorry, P. D. (2017). Targeting mental health care attributes by diagnosis and clinical stage: the views of youth mental health clinicians. Medical Journal of Australia207(10), 1926.Google Scholar
Hegelstad, W. T. V., Larsen, T. K., Auestad, B., Evensen, J., Haahr, U., Joa, I., … McGlashan, T. (2012). Long-term follow-up of the TIPS early detection in psychosis study: effects on 10-year outcomeAmerican Journal of Psychiatry169(4), 374380.Google Scholar
Hermens, D. F., Naismith, S. L., Lagopoulos, J., Lee, R. S., Guastella, A. J., Scott, E. M., & Hickie, I. B. (2013). Neuropsychological profile according to the clinical stage of young persons presenting for mental health careBMC Psychology1(1), 8.Google Scholar
Hetrick, S. E., Parker, A. G., Hickie, I. B., Purcell, R., Yung, A. R., & McGorry, P. D. (2008). Early identification and intervention in depressive disorders: towards a clinical staging modelPsychotherapy and Psychosomatics77(5), 263270.Google Scholar
Hickie, I. B., Scott, E. M., Hermens, D. F., Naismith, S. L., Guastella, A. J., Kaur, M., … McGorry, P. D. (2013a). Applying clinical staging to young people who present for mental health careEarly Intervention in Psychiatry7(1), 3143.Google Scholar
Hickie, I. B., Scott, J., Hermens, D. F., Scott, E. M., Naismith, S. L., Guastella, A. J., … McGorry, P. D. (2013b). Clinical classification in mental health at the cross-roads: which direction next? BMC Medicine11(1), 125.Google Scholar
Hilferty, F., Cassells, R., Muir, K., Duncan, A., Christensen, D., Mitrou, F., … Katz, I. (2015). Is headspace making a difference to young people’s lives? Final report of the independent evaluation of the headspace program. Sydney: Social Policy Research Centre, UNSW Australia.Google Scholar
Insel, T. R. (2007). The arrival of preemptive psychiatryEarly Intervention in Psychiatry1(1), 56.Google Scholar
Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of psychiatric diagnosesAmerican Journal of Psychiatry160(1), 412.Google Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey ReplicationArchives of General Psychiatry62(6), 593602.Google Scholar
Kessler, R. C., & Price, R. H. (1993). Primary prevention of secondary disorders: a proposal and agendaAmerican Journal of Community Psychology21(5), 607633.Google Scholar
Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H., Milne, B. J., & Poulton, R. (2003). Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohortArchives of General Psychiatry60(7), 709717.Google Scholar
Lagopoulos, J., Hermens, D. F., Naismith, S. L., Scott, E. M., & Hickie, I. B. (2012). Frontal lobe changes occur early in the course of affective disorders in young peopleBMC Psychiatry12(1), 4.Google Scholar
Lichtenstein, P., Yip, B. H., Björk, C., Pawitan, Y., Cannon, T. D., Sullivan, P. F., & Hultman, C. M. (2009). Common genetic determinants of schizophrenia and bipolar disorder in Swedish families: a population-based studyLancet373(9659), 234239.Google Scholar
McGorry, P. D. (2010). Staging in neuropsychiatry: a heuristic model for understanding, prevention and treatmentNeurotoxicity Research18(3–4), 244255.CrossRefGoogle ScholarPubMed
McGorry, P. D. (2013). The next stage for diagnosis: validity through utilityWorld Psychiatry12(3), 213215.Google Scholar
McGorry, P. D. (2017). Youth mental health: building beyond the brand. Medical Journal of Australia, 207(10), 428429.Google Scholar
McGorry, P. D., Hickie, I. B., Yung, A. R., Pantelis, C., & Jackson, H. J. (2006). Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventionsAustralian and New Zealand Journal of Psychiatry40(8), 616622.Google Scholar
McGorry, P., Keshavan, M., Goldstone, S., Amminger, P., Allott, K., Berk, M., … Hickie, I. (2014). Biomarkers and clinical staging in psychiatryWorld Psychiatry13(3), 211223.Google Scholar
McGorry, P., Killackey, E., Lambert, T., & Lambert, M. (2005). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders. Australian and New Zealand Journal of Psychiatry, 39(1–2), 130.Google Scholar
McGorry, P. D., Killackey, E., & Yung, A. (2008). Early intervention in psychosis: concepts, evidence and future directionsWorld Psychiatry7(3), 148156.CrossRefGoogle ScholarPubMed
McGorry, P., & Nelson, B. (2016). Why we need a transdiagnostic staging approach to emerging psychopathology, early diagnosis, and treatmentJAMA Psychiatry73(3), 191192.Google Scholar
McGorry, P. D., Nelson, B., Goldstone, S., & Yung, A. R. (2010). Clinical staging: a heuristic and practical strategy for new research and better health and social outcomes for psychotic and related mood disordersCanadian Journal of Psychiatry55(8), 486497.Google Scholar
McGorry, P. D., Purcell, R., Hickie, I. B., Yung, A. R., Pantelis, C., & Jackson, H. J. (2007). Clinical staging: a heuristic model for psychiatry and youth mental healthMedical Journal of Australia, 187(7), S40S42.Google Scholar
McGorry, P., & van Os, J. (2013). Redeeming diagnosis in psychiatry: timing versus specificityLancet381(9863), 343345.Google Scholar
Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication – Adolescent Supplement (NCS-A)Journal of the American Academy of Child and Adolescent Psychiatry49(10), 980989.CrossRefGoogle ScholarPubMed
Naismith, S. L., Hermens, D. F., Ip, T. K., Bolitho, S., Scott, E., Rogers, N. L., & Hickie, I. B. (2012). Circadian profiles in young people during the early stages of affective disorderTranslational Psychiatry2(5), e123.Google Scholar
National Mental Health Commission (NMHC). (2014). Contributing lives, thriving communities: report of the national review of mental health programmes and services. Canberra: NMHC.Google Scholar
Nelson, B., Amminger, G. P., Yuen, H. P., Wallis, N., Kerr, M. J., Dixon, L., … McGorry, P. D. (2018). Staged treatment in early psychosis: a sequential multiple assignment randomised trial of interventions for ultra high risk of psychosis patients. Early Intervention in Psychiatry, 12(3), 292306.Google Scholar
Nelson, B., Yuen, H. P., Wood, S. J., Lin, A., Spiliotacopoulos, D., Bruxner, A., … Yung, A. R. (2013). Long-term follow-up of a group at ultra high risk (‘prodromal’) for psychosis: the PACE 400 studyJAMA Psychiatry70(8), 793802.Google Scholar
Patton, G. C., Coffey, C., Romaniuk, H., Mackinnon, A., Carlin, J. B., Degenhardt, L., … Moran, P. (2014). The prognosis of common mental disorders in adolescents: a 14-year prospective cohort studyLancet383(9926), 14041411.Google Scholar
Purcell, R., Jorm, A. F., Hickie, I. B., Yung, A. R., Pantelis, C., Amminger, G. P., … McGorry, P. D. (2015). Demographic and clinical characteristics of young people seeking help at youth mental health services: baseline findings of the Transitions StudyEarly Intervention in Psychiatry9(6), 487497.Google Scholar
Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, part II: test–retest reliability of selected categorical diagnosesAmerican Journal of Psychiatry170 (1), 5970.Google Scholar
Rickwood, D. J., Mazzer, K. R., Telford, N. R., Parker, A. G., Tanti, C. J., & McGorry, P. D. (2015). Changes in psychological distress and psychosocial functioning in young people visiting headspace centres for mental health problemsMedical Journal of Australia202(10), 537542.Google Scholar
Rickwood, D. J., Telford, N. R., Parker, A. G., Tanti, C. J., & McGorry, P. D. (2014). headspace: Australia’s innovation in youth mental health – who are the clients and why are they presenting? Medical Journal of Australia200(2), 108111.Google Scholar
Scott, E. M., Hermens, D. F., Glozier, N., Naismith, S. L., Guastella, A. J., & Hickie, I. B. (2012a). Targeted primary care-based mental health services for young AustraliansMedical Journal of Australia196(2), 136140.Google Scholar
Scott, E. M., Hermens, D. F., Naismith, S. L., White, D., Whitwell, B., Guastella, A. J., … Hickie, I. B. (2012b). Thoughts of death or suicidal ideation are common in young people aged 12 to 30 years presenting for mental health careBMC Psychiatry12(1), 234.Google Scholar
Scott, E. M., Robillard, R., Hermens, D. F., Naismith, S. L., Rogers, N. L., Ip, T. K., … Hickie, I. B. (2016). Dysregulated sleep–wake cycles in young people are associated with emerging stages of major mental disordersEarly Intervention in Psychiatry10(1), 6370.CrossRefGoogle ScholarPubMed
Scott, J., Hickie, I. B., & McGorry, P. (2012c). Pre-emptive psychiatric treatments: pipe dream or a realistic outcome of clinical staging models? Neuropsychiatry2(4), 263266.Google Scholar
Scott, J., Leboyer, M., Hickie, I., Berk, M., Kapczinski, F., Frank, E., … McGorry, P. (2013). Clinical staging in psychiatry: a cross-cutting model of diagnosis with heuristic and practical value. British Journal of Psychiatry, 202, 243245.Google Scholar
Scott, J., Paykel, E., Morriss, R., Bentall, R., Kinderman, P., Johnson, T., … Hayhurst, H. (2006). Cognitive-behavioural therapy for severe and recurrent bipolar disorders. British Journal of Psychiatry188(4), 313320.Google Scholar
Treasure, J., Stein, D., & Maguire, S. (2015). Has the time come for a staging model to map the course of eating disorders from high risk to severe enduring illness? An examination of the evidenceEarly Intervention in Psychiatry9(3), 173184.Google Scholar
Tsuang, M. T., Bar, J. L., Stone, W. S., & Faraone, S. V. (2004). Gene–environment interactions in mental disordersWorld Psychiatry3(2), 7383.Google Scholar

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