Staging Models and Functional Outcomes in Bipolar Disorder: Clinical Implications

Opinion statementPrognostic staging has been gaining traction in psychiatry in the past few years. The heterogeneity of clinical presentations in bipolar disorder has been an important challenge to clinicians and researchers. Staging models attempt to overcome this problem by identifying clusters of patients with bipolar disorder who have a differential course of illness and response to treatments. There is an emerging body of knowledge suggesting that staging models based on functional outcomes (functional staging) may provide clinicians with a useful tool to predict the course of illness and organize treatment strategies to individual patients. For instance, it has been widely accepted that earlier interventions in BD are likely to be associated with a better response to treatment, and lower rates of functional impairment. Also, while treatments such as lithium monotherapy, cognitive behavioral therapy, and psychoeducation seem to be better suited to prevent further recurrences within patients with few episodes, complex pharmacological strategies and functional remediation might be considered in more severe patients. Therefore, the aim of the present work is to review the evidence related to the clinical use of functional staging models in bipolar disorder.