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


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.

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'.

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.

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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    • "We reviewed the available evidence on the longitudinal course of BD concerning any of the following clinical domains: (i) episodes recurrences, (ii) cognitive functioning, (iii) functional outcome, and (iv) response to treatment. First, we decided beforehand to include the clinical studies acknowledged as being " in favor " of the hypothesis of neuroprogression in previous reviews (Berk, 2009; Berk et al., 2011a, 2014; Cardoso et al., 2015; Cosci and Fava, 2013; Frank et al., 2015; Fries et al., 2012; Gama et al., 2013; Post et al., 2012; Rodriguez et al., 2014; Vieta et al., 2011, 2013). However, for the purpose of this report, we complemented those studies with additional material derived from literature search of relevant publications and with focus on the longitudinal clinical course of BD. "

    Full-text · Article · Jan 2016
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    • "Thus, it is important to recognise the distinctions between the model investigated in this current study and others in the literature. Comprehensive longitudinal research will help to determine the utility of staging within single disorders (see (Cosci and Fava 2013)) versus staging across a range of syndromes (Hickie et al. 2013b; Hickie et al. 2013a). "
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    ABSTRACT: Background: Clinical staging of mental disorders proposes that individuals can be assessed at various sub-syndromal and later developed phases of illness. As an adjunctive rating, it may complement traditional diagnostic silo-based approaches. In this study, we sought to determine the relationships between clinical stage and neuropsychological profile in young persons presenting to youth-focused mental health services. Methods: Neuropsychological testing of 194 help-seeking young people (mean age 22.6 years, 52% female) and 50 healthy controls. Clinical staging rated 94 persons as having an 'attenuated syndrome' (stage 1b) and 100 with a discrete or persistent disorder (stage 2/3). Results: The discrete disorder group (stage 2/3) showed the most impaired neuropsychological profile, with the earlier stage (1b) group showing an intermediate profile, compared to controls. Greatest impairments were seen in verbal memory and executive functioning. To address potential confounds created by 'diagnosis', profiles for those with a mood syndrome or disorder but not psychosis were also examined and the neuropsychological impairments for the stage 2/3 group remained. Conclusions: The degree of neuropsychological impairment in young persons with mental disorders appears to discriminate those with attenuated syndromes from those with a discrete disorder, independent of diagnostic status and current symptoms. Our findings suggest that neuropsychological assessment is a critical aspect of clinical evaluation of young patients at the early stages of a major psychiatric illness.
    Full-text · Article · May 2013
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    ABSTRACT: Mental illness has been observed to follow a neuroprogressive course, commencing with prodrome, then onset, recurrence and finally chronic illness. In bipolar disorder and schizophrenia responsiveness to treatment mirrors these stages of illness progression, with greater response to treatment in the earlier stages of illness and greater treatment resistance in chronic late stage illness. Using data from 5627 participants in 15 controlled trials of duloxetine, comparator arm (paroxetine, venlafaxine, escitalopram) or placebo for the treatment of an acute depressive episode, the relationship between treatment response and number of previous depressive episodes was determined. Data was dichotomised for comparisons between participants who had >3 previous episodes (n=1697) or ≤3 previous episodes (n=3930), and additionally for no previous episodes (n=1381) or at least one previous episode (n=4246). Analyses were conducted by study arm for each clinical trial, and results were then pooled. There was no significant difference between treatment response and number of previous depressive episodes. This unexpected finding suggests that treatments to reduce symptoms of depression during acute illness do not lose efficacy for patients with a longer history of illness.
    No preview · Article · May 2013 · Journal of Affective Disorders
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