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All the world’s a (clinical) stage: rethinking bipolar disorder from a longitudinal perspective

Molecular Psychiatry volume 20, pages 23–31 (2015)Cite this article

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Abstract

Psychiatric disorders have traditionally been classified using a static, categorical approach. However, this approach falls short in facilitating understanding of the development, common comorbid diagnoses, prognosis and treatment of these disorders. We propose a ‘staging’ model of bipolar disorder that integrates genetic and neural information with mood and activity symptoms to describe how the disease progresses over time. From an early, asymptomatic, but ‘at-risk’ stage to severe, chronic illness, each stage is described with associated neuroimaging findings as well as strategies for mapping genetic risk factors. Integrating more biologic information relating to cardiovascular and endocrine systems, refining methodology for modeling dimensional approaches to disease and developing outcome measures will all be crucial in examining the validity of this model. Ultimately, this approach should aid in developing targeted interventions for each group that will reduce the significant morbidity and mortality associated with bipolar disorder.

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Acknowledgements

This work was partially supported by NIMH Grants MH63480, TW008302 and MH09375, awarded to Dr Nimgaonkar; and MH092221-03, MH0922250, MH073953 and MH060952-12S1, awarded to Dr Phillips; MH081003 awarded to Drs Kupfer and Frank, and a bequest from the Mueller family. We thank Fiona C Ritchey, BA for her editorial assistance in preparing this manuscript

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  1. Departments of Psychiatry and Psychology, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    E Frank, V L Nimgaonkar, M L Phillips & D J Kupfer

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  1. E Frank
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  2. V L Nimgaonkar
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  3. M L Phillips
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Correspondence to E Frank.

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Drs Frank and Kupfer are consultants to the American Psychiatric Association and each has an equity interest in Psychiatric Assessments. Dr Frank receives royalties from Guilford Press and the American Psychological Association and has received honoraria from Servier and Lundbeck. The other authors have no conflict of interest to declare.

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Frank, E., Nimgaonkar, V., Phillips, M. et al. All the world’s a (clinical) stage: rethinking bipolar disorder from a longitudinal perspective. Mol Psychiatry 20, 23–31 (2015). https://doi.org/10.1038/mp.2014.71

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