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Clinical staging in psychiatry: a cross-cutting model of diagnosis with heuristic and practical value

  • Jan Scott (a1), Marion Leboyer (a2), Ian Hickie (a3), Michael Berk (a4), Flavio Kapczinski (a5), Ellen Frank (a6), David Kupfer (a7) and Patrick McGorry (a7)...
Summary

Staging models are used routinely in general medicine for potentially serious or chronic physical disorders such as diabetes, arthritis and cancers, describing the links between biomarkers, clinical phenotypes and disease extension, and promoting a personalised or stratified medicine approach to treatment planning. Clinical staging involves a detailed description of where an individual exists on a continuum of disorder progression from stage 0 (an at-risk or latency stage) through to stage IV (late or end-stage disease). The approach is popular owing to its clinical utility and is increasingly being applied in psychiatry. The concept offers an informed approach to research and the active promotion of indicated prevention and early intervention strategies. We suggest that for young persons with emerging bipolar disorder, such transdiagnostic staging models could provide a framework that better reflects the developmental psychopathology and matches the complex longitudinal inter-relationships between subsyndromal and syndromal mood, psychotic and other disorders.

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Copyright
Corresponding author
Jan Scott, Department of Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne NE1 7RU, UK. Email: jan.scott@newcastle.ac.uk
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Declaration of interest

None.

Footnotes
References
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1 McGorry, PD, Hickie, IB, Yung, AR, Pantelis, C, Jackson, HJ. Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Aust NZ J Psychiatry 2006; 40: 616–22.
2 Insel, T, Cuthbert, B, Garvey, M, Heinssen, R, Pine, DS, Quinn, K, et al Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry 2010: 167: 748–51.
3 Fava, GA, Kellner, R. Staging: a neglected dimenson in psychiatric classification. Acta Psychiatr Scand 1993; 87: 225–30.
4 Kapczinski, F, Dias, VV, Kauer-Sant'Anna, M, Frey, BN, Grassi-Oliveira, R, Colom, F, et al Clinical implications of a staging model for bipolar disorders. Expert Rev Neurother 2009; 9: 957–66.
5 Berk, M, Conus, P, Lucas, N, Hallam, K, Malhi, GS, Dodd, S, et al Setting the stage: from prodrome to treatment resistance in bipolar disorder. Bipolar Disord 2007; 9: 671–8.
6 Hickie, IB, Scott, EM, Hermens, DF, Naismith, SL, Guastella, AJ, Kaur, M, et al Applying clinical staging to young people who present for mental health care. Early interv Psychiatry 2013; 7: 3143.
7 Leboyer, M, Soreca, I, Scott, J, Frye, M, Henry, C, Tamouza, R, et al Can bipolar disorder be viewed as a multi-system inflammatory disease? J Affect Disord 2012; 141: 110.
8 Lagopoulos, J, Hermens, DF, Naismith, SL, Scott, EM, Hickie, IB. Frontal lobe changes occur early in the course of affective disorders in young people. BMC Psychiatry 2012; 12: 4.
9 Berk, M, Kapczinski, F, Andreazza, AC, Dean, OM, Glorlando, F, Maes, M, et al Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neurosci Biobehav Rev 2010; 35: 804–17.
10 Scott, J, Paykel, E, Morriss, R, Bentall, R, Kinderman, P, Johnson, T, et al Cognitive–behavioural therapy for severe and recurrent bipolar disorders. Randomised controlled trial. Br J Psychiatry 2006; 188: 313–20.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Clinical staging in psychiatry: a cross-cutting model of diagnosis with heuristic and practical value

  • Jan Scott (a1), Marion Leboyer (a2), Ian Hickie (a3), Michael Berk (a4), Flavio Kapczinski (a5), Ellen Frank (a6), David Kupfer (a7) and Patrick McGorry (a7)...
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eLetters

Continuum v. Spectrum Scott et al (1)

Michael Fitzgerald, Psychiatrist
01 July 2013

In discussing clinical staging in Psychiatry discuss the concept of a "continuum of disorder progression from stage zero through stage four". This is not appropriate to psychiatry as this suggests a continuous line. The correct word would be 'spectrum' which is a far more diffuse in one sense concept but has the value of at least describing accurately what we are talking about and does allow the possibility of discussing points on the spectrum.

(1) Scott J. Leboyer M. Hickie I. Berk M. Kapczinski F. Frank E. Kupfer D. McGorry P. Clinical Staging in Psychiatry: - Cutting Model of Diagnosis with Heuristic and practical value. British Journal of Psychiatry 2 13, 202, 243-245.

Professor Michael FitzgeraldTrinity College DublinPsychiatrist

Conflict of Interest: None declared

Conflict of Interest:None declared
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Conflict of interest: None Declared

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