Staging of bipolar affective illness
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Psychiatr Pol 2012;46(4):613–626
The concept of staging as a description of clinical advancement of illness is prevalent and commonly used in medicine. Regarding bipolar mood disorder (BD) a staging model assumes a progression from prodromal (at-risk) to more severe and treatment-refractory conditions. Four different staging models of BD have been proposed. The concept of Robert Post's is based on the phenomenon of kindling and neurosensitization, assuming a role of stressors in triggering the first episode of illness, with subsequent persistent changes in the activity of neurones, greater vulnerability to relapse and worse response to treatment. The concept of Anne Duffy's is based on the research of high risk bipolar offspring and describes the early development of the illness as successive stages, i.e. non-mood disorders, minor mood disorders and acute episodes of illness, starting in childhood, with an attempt to distinguish subtypes of the disease depending on the parent's response to prophylactic lithium treatment. The model of Michael Berk's has been constructed in parallel to the therapeutic algorithms and classifies the stages of illness based on clinical features, prognosis, and response to treatment. It also identifies high risk individuals, highlights need of early intervention and is proposed as a course specifier for BD. The model of Flavio Kapczinski's is based on a phenomenon of allostatic load and evaluation of the changes of biomarkers and cognitive functions during the episode and between episodes. A significant consequence of introducing the staging model is employing treatment which is adequate to a stage of the illness. The model underlines a necessity of early intervention and defines the first episode of the illness as a critical target of it, in a hope to a possibility of prevention against neuroanatomical, neuropsychological, clinical and functional consequence of the illness.