title: Pharmacological treatment and staging in bipolar disorder: evidence from clinical practice.
abstract: OBJECTIVE
  Staging models for medical diseases are widely used to guide treatment and prognosis. Bipolar disorder (BD) is a chronic condition and it is among the most disabling disorders in medicine. The staging model proposed by Kapczinski in 2009 presents four progressive clinical stages of BD. Our aim was to evaluate pharmacological maintenance treatment across these stages in patients with BD.
  
  
  METHODS
  One hundred and twenty-nine subjects who met DSM-IV criteria for BD were recruited from the Bipolar Disorders Program at Hospital de Clínicas de Porto Alegre, Brazil. All patients were in remission. The subjects were classified according to the staging model: 31 subjects were classified as stage I, 44 as stage II, 31 as stage III, and 23 as stage IV.
  
  
  RESULTS
  Patterns of pharmacological treatment differed among the four stages (p = 0.001). Monotherapy was more frequent in stage I, and two-drug combinations in stage II. Patients at stages III and IV needed three or more medications or clozapine. Impairment in functional status (Functioning Assessment Short Test [FAST] scale scores) correlated positively with the number of medications prescribed.
  
  
  CONCLUSIONS
  This study demonstrated differences in pharmacological treatment in patients with stable BD depending on disease stage. Treatment response can change with progression of BD. Clinical guidelines could consider the staging model to guide treatment effectiveness.
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Pedro D
authors.initials: PD
authors.lastname: Goi
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Joana
authors.initials: J
authors.lastname: Bücker
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Mireia
authors.initials: M
authors.lastname: Vianna-Sulzbach
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Adriane R
authors.initials: AR
authors.lastname: Rosa
authors.affiliation: Clinical Institute of Neuroscience, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Iria
authors.initials: I
authors.lastname: Grande
authors.affiliation: Psychiatry and Mental Health Service, Department of Neurosciences, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Ines
authors.initials: I
authors.lastname: Chendo
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Leonardo A
authors.initials: LA
authors.lastname: Sodré
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Kauer-Sant'Anna
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Silveira
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Kunz
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Keila M
authors.initials: KM
authors.lastname: Ceresér
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Clarissa S
authors.initials: CS
authors.lastname: Gama
authors.affiliation: Laboratory of Molecular Psychiatry;National Science and Technology Institute for Translational Medicine (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), RS, Porto Alegre, Brazil.
authors.forename: Raffael
authors.initials: R
authors.lastname: Massuda
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage*; D000928:Antidepressive Agents / Q000008:administration & dosage*; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D001714:Bipolar Disorder / Q000145:classification / Q000188:drug therapy*; D001938:Brazil; D002985:Clinical Protocols; D003024:Clozapine / Q000008:administration & dosage*; D018450:Disease Progression; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010818:Practice Patterns, Physicians'; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D012959:Socioeconomic Factors
chemical_list: D000927:Anticonvulsants; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D003024:Clozapine