Article

Staging of Mental Disorders: Systematic Review

Department of Psychology, University of Florence, Florence, Italy.
Psychotherapy and Psychosomatics (Impact Factor: 9.2). 01/2013; 82(1):20-34. DOI: 10.1159/000342243
Source: PubMed
ABSTRACT
Background:
The staging method, whereby a disorder is characterized according to its seriousness, extension, development and features, is attracting increasing attention in clinical psychology and psychiatry. The aim of this systematic review was to critically summarize the tools that are available for reproducing and standardizing the clinical intuitions that are involved in a staging formulation.

Methods:
A comprehensive research was conducted on the MEDLINE, PsycINFO, EMBASE and Cochrane databases from inception to May 2012. The following search terms were used: 'stage/staging' AND 'psychiatric disorder/mental disorder/schizophrenia/mood disorder/anxiety disorder/substance use disorder/eating disorder'.

Results:
A total of 78 studies were identified for inclusion in the review. We discussed studies addressing or related to the issue of staging in a number of mental disorders (schizophrenia, unipolar depression, bipolar disorder, panic disorder, substance use disorders, anorexia and bulimia nervosa). The literature indicates that disorders have a longitudinal development or a treatment history that can be categorized according to stages. We proposed staging formulations for the above-mentioned psychiatric disorders.

Conclusion:
Staging models offer innovative assessment tools for clinical psychologists and psychiatrists. Characterizing each stage of an illness demarcates major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis. A stage 0 to denote an at-risk condition does not appear to be warranted at the current state of research.

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Available from: Fiammetta Cosci, Feb 18, 2014
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    • "This study used a simplified clinical staging model for MDD based on McGorry et al. (2006). Although clinical staging is an upcoming model for mental disorders (Cosci and Fava, 2013), it has not been extensively validated. Despite some evidence in favor of staging including structural MRI changes (Velakoulis et al., 1999) and rising psychological distress and disability in more severe stages of MDD (Hamilton et al., 2011), depression course tends to fluctuate over time (Penninx et al., 2011) and staging depressive disorders does not presume that patients remain in the pertinent stage over any fixed period of time. "
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    • "Moreover, in that context, alterations in biomarkers and structural or functional neuroimaging might reflect differences in pathophysiological pathways among subgroups of patients rather than progression through different stages of illness as is often suggested ( Berk et al., 2011b Berk et al., , 2014 Post et al., 2012; Rodriguez et al., 2014; Vieta et al., 2011 Vieta et al., , 2013). Altogether, there are multiple knowledge gaps and constraints to conclude in the light of current clinical evidence that BD is a neuroprogressive condition as suggested in previous reviews ( Berk et al., 2011b Berk et al., , 2014 Cardoso et al., 2015; Cosci and Fava, 2013; Fries et al., 2012; Gama et al., 2013; Post et al, 2012; Rodriguez et al, 2014; Vieta et al., 2011 Vieta et al., , 2013). Therefore, we should be extremely rigorous and cautious with the interpretation of the data, given that wrongly considering BD as " a neuroprogressive illness " might involve a number of serious negative consequences. "
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    • "ls with 2 episodes have an approximate 60% chance; and individuals with three episodes the risk is as high as 90% (Eaton et al., 2008; Moffitt et al., 2010; Solomon et al., 2000). Such statistics emphasize the importance of interventions that can disrupt patterns of repeated depressive relapse/recurrence and enable sustained remission and recovery. Cosci and Fava (2013) recently hypothesized an integrated model of staging for unipolar depression in line with concepts used in the medical field and developmental psychology. For this staging model 5 stages were defined, which will require empirical validation. Stage 1 represents the prodromal phase including mood symptoms (sad mood, subsyndromal depressio"
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