Staging of Mental Disorders: systematic review

Background: The staging method, whereby a disorder is characterized according to seriousness, extension, development, and features, is attracting increasing attention in clinical psychology and psychiatry. The aim of this systematic review was to critically summarize the tools that are available for reproducing and standardizing the clinical intuitions that are concerned with a staging formulation. Methods: A comprehensive research was conducted on MEDLINE, PsycINFO, EMBASE, and Cochrane from inception to May 2012. Search terms were: ‘stage/staging’ AND ‘psychiatric disorder/mental disorder/schizophrenia/mood disorder/anxiety disorder/substance use disorder/eating disorder’. Results: A total of 78 studies were identified for inclusion in the review. We discussed studies addressing or related to the issue of staging in a number of mental disorders (schizophrenia, unipolar depression, bipolar disorder, panic disorder, substance use disorders, anorexia and bulimia nervosa). The literature indicates that disorders have a longitudinal development or a treatment history that can be categorized according to stages. We proposed staging formulations for the above mentioned psychiatric disorders. Conclusion: Staging models offer innovative assessment tools for clinical psychologists and psychiatrists. Characterizing each stage of the illness demarcates major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis. A stage 0 to connote a condition at risk does not appear to be warranted at the current status of research.