Do the Trajectories of Bipolar Disorder and Schizophrenia Follow a Universal Staging Model?
Open accessAbstract
Objective: The purpose of this study is to address the question of whether a universal staging model of severe psychiatric disorders is a viable direction for future research by examining the extant literature. Method: A narrative review was conducted of the relevant historical, conceptual, and empirical literature pertaining to the clinical trajectory of bipolar disorder and schizophrenia and issues relevant to staging. Results: There is substantive evidence that classic recurrent bipolar disorder is separable from schizophrenia on the basis of family history, developmental and clinical course, treatment response, and neurobiological findings. However, because of the intrinsic heterogeneity of diagnostic categories that has been amplified by recent changes in psychiatric taxonomy, key distinctions between the groups have become obfuscated. While mapping risk and illness markers to emerging psychopathology is a logical approach and may be of value for some psychiatric disorders and/or their clinical subtypes, robust evidence supporting identifiable stages per se is still lacking. Presently, even rudimentary stages such as prodromes cannot be meaningfully applied across different disorders and no commonalities can be found for the basis of universal staging. Conclusions: Advances in the prediction of risk, accurate early illness detection, and tailored intervention will require mapping biomarkers and other risk indicators to reliable clinical phases of illness progression. Given the capricious nature of mood and psychotic disorders, this task is likely to yield success only if conducted in narrowly defined subgroups of individuals at high risk for specific illnesses. This approach is diametrically opposite to that being promulgated by proponents of a universal staging model.
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There are concerns that the natural course of bipolar and depressive disorders does not follow a clinical staging model.
“There are also concerns that the natural course of bipolar 220 and depressive 221 disorders does not follow a clinical staging model.”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [220]
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Intellectual functioning in schizophrenia: a marker of neurodevelopmental damage?
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Self-citationDiagnostic Stability and Bipolar Disorder in Youth
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Resolving the Discrepancy in Childhood Bipolar High-Risk Study Findings
Duffy, A. C., Grof, P., Hájek, T., et al. (2010) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.10020170 · Cited by 4 · see citing works
Self-citation
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Improving outcomes of first‐episode psychosis: an overview
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Preventive psychiatry: a blueprint for improving the mental health of young people
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Staging in bipolar disorder: from theoretical framework to clinical utility
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Faedda, G. L., Baldessarini, R. J., Marangoni, C., Bechdolf, A., Berk, M., Birmaher, B., Conus, P., DelBello, M. P., Duffy, A. C., Hillegers, M. H. J., et al. (2019) · Bipolar Disorders · doi:10.1111/bdi.12831 · Cited by 124 · see citing works
Self-citationChanging the bipolar illness trajectory
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Self-citation
- Authors
- Duffy, A., Malhi, G. S., & Grof, P.
- Affiliations
- University of Calgary (CA)
- The University of Sydney (AU)
- University of Toronto (CA)
- Corresponding author
- Duffy, Anne
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2016-07-09
- Volume
- 62
- Issue
- 2
- Pages
- 115-122
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- PMC
- PMC5298521
- OpenAlex
- W2429007347
- Cited by
- 46
- References
- 102
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 5 · 2019: 6 · 2018: 9 · 2017: 7 · 2016: 2
- FWCI
- 7.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- bipolar disorder, schizophrenia, disease staging, clinical trajectories, prodromal symptoms, psychiatric classification, diagnostic heterogeneity, risk biomarkers, early illness detection, mood disorders, psychosis, disease progression
- MeSH terms
- Bipolar Disorder, Humans, Schizophrenia, Disease Progression, Prodromal Symptoms
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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