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.


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. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Depression and ADHD often co-occur in clinical samples. Depression severity may be linked to ADHD symptomatology. We therefore assessed ADHD symptoms across clinical stages of major depressive disorder (MDD). Methods: We used 4-year follow-up data of the Netherlands Study of Depression and Anxiety (September 2008 until April 2011), including healthy controls, groups with remitted and current MDD (N=2053; age range 21-69 years; 66.8% females). Probable ADHD was defined as having current ADHD symptoms on the Conners Adult ADHD Rating Scale and a positive score on childhood or early-adolescent ADHD indicators. We examined ADHD symptom rates across (i) those with and without lifetime MDD, (ii) clinical characteristics of MDD including severity, course and outcomes, (iii) clinical stages of MDD. Results: (i) The prevalence of ADHD symptoms was 0.4% in healthy controls, 5.7% in remitted MDD and 22.1% in current MDD (OR=4.5; 95% CI 3.1-6.5). (ii) ADHD symptom rates and odds were significantly increased among those with more severe depression (29.4%; OR=6.8; 95% CI 2.9-16.1), chronic depression (21.8%; OR=3.8; 95% CI 2.5-5.7), earlier age of onset of depressive symptoms (9.9%; OR=1.5; 95% CI 1.0-2.3), and comorbid anxiety disorders (29.0%; OR=3.4; 95% CI 2.0-5.7). (iii) ADHD symptom rates increased across clinical stages of MDD, up to 22.5% in chronic MDD. Limitations: We used self-reports on ADHD symptoms. Also, clinical staging models have not yet been validated for mental disorders. Conclusions: ADHD symptoms are very common among MDD patients, especially among those in recurrent and chronic stages of MDD. Considering ADHD may be an important step forward in improving the treatment of depression.
    Full-text · Article · Mar 2016 · Journal of Affective Disorders
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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. "
    Full-text · Article · Jan 2016
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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"
    [Show abstract] [Hide abstract] ABSTRACT: Prevention of recurrence is a challenge in the management of major depressive disorder (MDD). The long-term effects of Preventive Cognitive Therapy (PCT) in preventing recurrence in MDD are not known. A RCT comparing the addition of PCT to Treatment As Usual (TAU), versus TAU including patients with recurrent depression who were in remission at entry (N=172). PCT consisted of eight weekly group sessions. TAU involved standard treatment. Primary outcome is time to first recurrence of a depressive episode as assessed by blinded interviewers over 10 years based on DSM-IV-TR criteria. Also over 10 years, the protective effect of PCT was dependent on the number of previous episodes a patient experienced. The protective effect intensified with the number of previous depressive episodes (Cox regression; p=.004, Hazard ratio=.576, 95% CI=.396-.837) and is mainly established within the first half of the 10 year follow-up period. For patients with more than three previous episodes (52% of the sample), PCT significantly increased the median survival time (713.0 days) versus patients that received TAU (205.0 days). No enduring effects were found on secondary outcomes. Dropout rates were relatively high for secondary outcomes, but relatively low for the primary outcome. Results were comparable after multiple imputation. PCT in remitted patients with multiple prior episodes has long-term preventive effects on time to recurrence. To reduce recurrence rates, booster sessions might be necessary. A personalized medicine approach might be necessary to reduce recurrence rates even further. Copyright © 2015 Elsevier B.V. All rights reserved.
    Full-text · Article · Jul 2015 · Journal of Affective Disorders
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