title: All the world's a (clinical) stage: rethinking bipolar disorder from a longitudinal perspective.
abstract: Psychiatric disorders have traditionally been classified using a static, categorical approach. However, this approach falls short in facilitating understanding of the development, common comorbid diagnoses, prognosis and treatment of these disorders. We propose a 'staging' model of bipolar disorder that integrates genetic and neural information with mood and activity symptoms to describe how the disease progresses over time. From an early, asymptomatic, but 'at-risk' stage to severe, chronic illness, each stage is described with associated neuroimaging findings as well as strategies for mapping genetic risk factors. Integrating more biologic information relating to cardiovascular and endocrine systems, refining methodology for modeling dimensional approaches to disease and developing outcome measures will all be crucial in examining the validity of this model. Ultimately, this approach should aid in developing targeted interventions for each group that will reduce the significant morbidity and mortality associated with bipolar disorder.
authors.affiliation: Departments of Psychiatry and Psychology, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Frank
authors.affiliation: Departments of Psychiatry and Psychology, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: V L
authors.initials: VL
authors.lastname: Nimgaonkar
authors.affiliation: Departments of Psychiatry and Psychology, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Phillips
authors.affiliation: Departments of Psychiatry and Psychology, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Kupfer
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000628:therapy*; D015897:Comorbidity; D018450:Disease Progression; D020022:Genetic Predisposition to Disease; D006801:Humans; D008137:Longitudinal Studies; D008954:Models, Biological; D059906:Neuroimaging; D012307:Risk Factors