Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

doi:10.1111/bdi.13105

Review

. 2021 Nov;23(7):659-678.

doi: 10.1111/bdi.13105. Epub 2021 Jul 23.

Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

Ralph Kupka¹, Anne Duffy^{2

3}, Jan Scott^{4

5}, Jorge Almeida⁶, Vicent Balanzá-Martínez⁷, Boris Birmaher⁸, David J Bond⁹, Elisa Brietzke^{10

11}, Ines Chendo^{12

13}, Benicio N Frey^{14

15}, Iria Grande¹⁶, Danella Hafeman¹⁷, Tomas Hajek¹⁸, Manon Hillegers¹⁹, Marcia Kauer-Sant'Anna²⁰, Rodrigo B Mansur^{21

22}, Afra van der Markt¹, Robert Post^{23

24}, Mauricio Tohen²⁵, Hailey Tremain^{26

27}, Gustavo Vazquez²⁸, Eduard Vieta²⁹, Lakshmi N Yatham³⁰, Michael Berk^{31

32}, Martin Alda³³, Flávio Kapczinski^{34

35}

Affiliations

¹ Department of Psychiatry, Amsterdam Public Mental Health Research Insitute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
² Department of Psychiatry, Division of Student Mental Health, Queen's University, Cote Sharp Student Wellness Centre, Kingston, ON, Canada.
³ Department of Psychiatry, University of Oxford, Oxford, UK.
⁴ Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
⁵ Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
⁶ Department of Psychiatry and Behavior Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
⁷ Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain.
⁸ University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁹ Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁰ Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.
¹¹ Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
¹² Psychiatry Department, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal.
¹³ Clínica Universitária de Psiquiatria, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
¹⁴ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
¹⁵ Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
¹⁶ Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
¹⁷ Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
¹⁸ Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
¹⁹ Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
²⁰ Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS, Hospital de Clínicas de Porto Alegre (HCPA, Porto Alegre, Brazil.
²¹ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
²² Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
²³ George Washington University School of Medicine, Washington, DC, USA.
²⁴ Bipolar Collaborative Network, Bethesda, MD, USA.
²⁵ Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
²⁶ Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia.
²⁷ Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.
²⁸ Department of Psychiatry, Queen's University, Kingston, ON, Canada.
²⁹ Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
³⁰ Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
³¹ IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Vic, Australia.
³² Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Vic, Australia.
³³ Department of Psychiatry, Mood Disorders Clinic, Dalhousie University, Halifax, NC, Canada.
³⁴ St. Joseph's Healthcare Hamilton McMaster University, Hamilton, ON, Canada.
³⁵ Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.

PMID: 34174130
PMCID: PMC9290926
DOI: 10.1111/bdi.13105

Review

Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

Ralph Kupka et al. Bipolar Disord. 2021 Nov.

. 2021 Nov;23(7):659-678.

doi: 10.1111/bdi.13105. Epub 2021 Jul 23.

Authors

Affiliations

¹ Department of Psychiatry, Amsterdam Public Mental Health Research Insitute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
² Department of Psychiatry, Division of Student Mental Health, Queen's University, Cote Sharp Student Wellness Centre, Kingston, ON, Canada.
³ Department of Psychiatry, University of Oxford, Oxford, UK.
⁴ Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.
⁵ Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
⁶ Department of Psychiatry and Behavior Sciences, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
⁷ Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia, CIBERSAM, Valencia, Spain.
⁸ University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁹ Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁰ Department of Psychiatry, Queen's University School of Medicine, Kingston, ON, Canada.
¹¹ Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.
¹² Psychiatry Department, Department of Neurosciences, Hospital Santa Maria, Lisbon, Portugal.
¹³ Clínica Universitária de Psiquiatria, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
¹⁴ Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
¹⁵ Mood Disorders Program and Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
¹⁶ Barcelona Bipolar Disorders and Depressive Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
¹⁷ Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
¹⁸ Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
¹⁹ Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
²⁰ Department of Psychiatry, Faculty of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS, Hospital de Clínicas de Porto Alegre (HCPA, Porto Alegre, Brazil.
²¹ Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada.
²² Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
²³ George Washington University School of Medicine, Washington, DC, USA.
²⁴ Bipolar Collaborative Network, Bethesda, MD, USA.
²⁵ Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
²⁶ Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia.
²⁷ Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.
²⁸ Department of Psychiatry, Queen's University, Kingston, ON, Canada.
²⁹ Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
³⁰ Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
³¹ IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Vic, Australia.
³² Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Department of Psychiatry, The University of Melbourne, Melbourne, Vic, Australia.
³³ Department of Psychiatry, Mood Disorders Clinic, Dalhousie University, Halifax, NC, Canada.
³⁴ St. Joseph's Healthcare Hamilton McMaster University, Hamilton, ON, Canada.
³⁵ Universidade Federal do Rio Grande do Sul, UFRGS, Porto Alegre, Brazil.

PMID: 34174130
PMCID: PMC9290926
DOI: 10.1111/bdi.13105

Abstract

Objectives: Clinical staging is widely used in medicine to map disease progression, inform prognosis, and guide treatment decisions; in psychiatry, however, staging remains a hypothetical construct. To facilitate future research in bipolar disorders (BD), a well-defined nomenclature is needed, especially since diagnosis is often imprecise with blurred boundaries, and a full understanding of pathophysiology is lacking.

Methods: Under the auspices of the International Society of Bipolar Disorders, a Task Force of international experts was convened to review, discuss, and integrate findings from the scientific literature relevant to the development of a consensus staging model and standardize a terminology that could be used to advance future research including staging of BD and related disorders.

Results: Consensus opinion and areas of uncertainty or difference were identified in regard to terms referring to staging as it may apply to BD, to at-risk status and subthreshold stages, and to various clinical stages of BD as it is currently diagnosed.

Conclusion: The use of a standardized nomenclature about the clinical stages of BD will facilitate communication about research on clinical and pathological components of this heterogeneous group of disorders. The concepts presented are based on current evidence, but the template provided allows for further refinements as etiological advances come to light.

Keywords: bipolar disorders; clinical staging; nomenclature.

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References

1. Gospodarowicz MK, Wittekind C, Brierley JD. eds. TNM classification of malignant tumors, 8th edn. Wiley & Sons; 2016.
1. Scott S, Henry C. Clinical staging models: from general medicine to mental disorders. BJPsych Advances. 2017;23:292‐299.
1. Vieta E, Reinares M, Rosa AR. Staging bipolar disorder. Neurotox Res. 2011;19(2):279‐285. - PubMed
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1. World Health Organization . (2019). International Statistical Classification of Diseases and Related Health Problems (11th ed.; ICD‐11).

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[1] Gospodarowicz MK, Wittekind C, Brierley JD. eds. TNM classification of malignant tumors, 8th edn. Wiley & Sons; 2016.

[2] Gospodarowicz MK, Wittekind C, Brierley JD. eds. TNM classification of malignant tumors, 8th edn. Wiley & Sons; 2016.

[3] Scott S, Henry C. Clinical staging models: from general medicine to mental disorders. BJPsych Advances. 2017;23:292‐299.

[4] Scott S, Henry C. Clinical staging models: from general medicine to mental disorders. BJPsych Advances. 2017;23:292‐299.

[5] Vieta E, Reinares M, Rosa AR. Staging bipolar disorder. Neurotox Res. 2011;19(2):279‐285. - PubMed

[6] Vieta E, Reinares M, Rosa AR. Staging bipolar disorder. Neurotox Res. 2011;19(2):279‐285. - PubMed

[7] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association; 2013.

[8] American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Association; 2013.

[9] World Health Organization . (2019). International Statistical Classification of Diseases and Related Health Problems (11th ed.; ICD‐11).

[10] World Health Organization . (2019). International Statistical Classification of Diseases and Related Health Problems (11th ed.; ICD‐11).

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Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

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Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

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