Staging models applied in a sample of patients with bipolar disorder: Results from a retrospective cohort study

Background: Bipolar Disorder (BD) is a life-long illness with compelling evidence of progression. Although different staging models have been proposed to evaluate its course, clinical data remain limited. The aim of the present study was to retrospectively assess applicability of available staging approaches and their pattern of progression in a sample of bipolar patients. Methods: In a naturalistic sample of 100 BD patients, retrospective assessment of clinical stages was performed at four time points over 10 years, according to four staging models. Staging progression with potential associations between stages and unfavourable illness characteristics were analyzed. Results: A pattern of stage worsening emerged for each model, with a significant increase at every time point. Greater stage increases emerged in patients with lower educational level, age at first elevated episode <= 35 years, duration of illness <= 25 years, and duration of untreated illness <= 5 years. Lower stage values were associated with BD II, no psychiatric hospitalization, depressive onset and predominant polarity, <= three lifetime episodes, age at first mood stabilizer >40 years, duration of illness <= 25 years, and engaged/employed status. Higher stage values were associated with lower age at first elevated episode and mood stabilizing treatment instead. Limitations: Naturalistic and retrospective design, recruitment at a 2nd level specialistic clinic. Conclusions: Reported findings support the progressive nature of BD and the application of staging models for early intervention, suggesting a conceptualization of a standardized approach to better characterize patients, predict their clinical course, and deliver tailored treatment options.