Bipolar disorder staging and the impact it has on its management: an update

ABSTRACT

Introduction

The longitudinal course of bipolar disorder (BD) is associated with an active process of neuroprogression, characterized by structural brain alterations and progressive functional impairment. In the last decades, a growing need of a standardized staging model for BD arose, with the aim of a more appropriate definition of stage-specific clinical manifestations and the identification of more customized therapeutic tools.

Areas covered

The authors review the literature on clinical aspects, neurobiological correlates and treatment issues related to BD progression. Thereafter, they address the definition, constructs, and evolution of the staging concept, focusing on the clinical applications of BD staging models available in literature.

Expert opinion

Although several staging models for BD have been proposed to date, their application in clinical practice is still relatively scant. This may have a detrimental impact on the clinical and therapeutic management of BD, in terms of early and proper diagnosis as well as tailored treatment interventions according to the different stages of illness. Future research efforts should tend to the integration of recent insights on neuroimaging and epigenetic markers, toward a standardized and multidimensional staging model.

KEYWORDS:

• Bipolar disorder
• management
• progression
• staging models
• staging bipolar disorder

Article highlights

• Bipolar disorder (BD) is a severe and complex disease, which encompasses various manifestations, usually worsening during the course of illness.

• Active neuroprogression pathways have been found to sustain BD progression.

• Staging models help to identify and classify the progression of BD, allowing for targeted treatment interventions.

• Several models have been proposed, with some focusing on episode frequency, while others considering genetic and environmental factors, neurobiological changes, and functional outcomes.

• Staging models can guide clinicians in selecting the appropriate interventions, emphasizing the importance of early detection and consistent monitoring. The right therapeutic strategies can potentially slow the progression of BD, leading to better outcomes for patients.

Declaration of interest

B Dell’Osso has received honoraria for lecturing and grants from Angelini, Lundbeck, Janssen Pharmaceuticals, Pfizer Inc, Otzuka, Neuraxpharm, and Livanova over the past three years. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.