Towards an Integrated Staging Model for Bipolar Disorders: An International Society for Bipolar Disorders (ISBD) Staging Task Force Consensus Report.

OBJECTIVES

Three clinical staging models for bipolar disorder (BD) have been published, each with a different but complementary approach and focus. The International Society for Bipolar Disorders Staging Task Force aimed to integrate these models into one comprehensive three-dimensional staging model, separately rating bipolar spectrum, nonmood psychopathology, and (inter-episodic) functional impairment.

METHOD: Via a series of in-person and online meetings, Delphi-surveys, and email discussions, the task force members step-by-step reached consensus on the overall structure of the model and the definition of the various stages.

RESULTS

The resulting BD staging model describes the progression of mood psychopathology, nonmood psychopathology, and functional impairment in three independently rated dimensions. The stages of the mood psychopathology are M0 (at risk for BD having a 1st or 2nd degree family member with BD); M1 (prodromal); M2 (first episode classifying for BD-I or BD-II); M3 (recurrent BD); and M4 (chronic unremitting BD), with various substages. Single or recurrent major depression in persons at familial risk for BD is positioned in stage M1. The stages for nonmood psychopathology are: N0 (no symptoms); N1 (subsyndromal symptoms); N2 (one nonmood disorder); N3 (two nonmood disorders); N4 (three or more nonmood disorders). The stages for functional impairment are: F0 (no); F1 (mild); F2 (moderate); F3 (marked); and F4 (severe impairment). Fictitious case vignettes are presented to demonstrate how to apply the model. Limitations of clinical staging are discussed.

CONCLUSION

The proposed three-dimensional clinical staging model for illness progression comprehensively captures the complexity of illness presentation and heterogeneous illness progression in BD, including psychiatric comorbidities and degree of functional impairment. The model provides a framework that requires validation in research and clinical practice.