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Clinical Staging of Psychiatric Disorders: Its Utility in Mental Health Prevention

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Prevention in Mental Health

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Abstract

The current classification of mental disorders fails to represent the progressive and pluripotential nature of emerging psychopathology. In analogy with other medical disciplines, above all oncology, a clinical staging framework has been proposed to facilitate early illness detection and stratified interventions. Clinical staging lies on some fundamental assumptions: disease progression is not inevitable; interventions addressing early stages may arrest progression; and early interventions have better cost-effectiveness ratios. A prototypical clinical staging model has been described, encompassing stage 0, preclinical genetic vulnerability; stage 1, clinical high-risk state; stage 2, full-threshold first episode; stage 3, late/incomplete recovery; and stage 4, chronicity. Stage 1 of psychotic disorders has received much attention, under the paradigm of at-risk mental states (ARMS). However, clinical staging has been also applied to bipolar and major depressive disorders. After 25 years from the ARMS formulation, it has become evident that early stages of psychopathology are characterized by pluripotency (i.e., developing multiple possible outcomes) and heterotypy (i.e., symptoms progressing from one category to the other). This paved the way for a transdiagnostic approach to clinical staging. The future perspective is to integrate data on stage-specific biological, social, and environmental factors, to build a more robust clinicopathological model. Most of these factors are indeed modifiable hence amenable to treatment, and may be targeted by preventive interventions. In this chapter, we highlight the promise and limitations of the clinical staging model and its potential application for a more personalized and staged-care approach to mental disorders.

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Authors and Affiliations

  1. Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK

    Grazia Rutigliano

  2. Azienda USL Toscana Nord Ovest, UFSMA Zona Pisana, Pisa, Italy

    Claudia Del Grande

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  1. Grazia Rutigliano
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  2. Claudia Del Grande
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Correspondence to Grazia Rutigliano .

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Editors and Affiliations

  1. Department of Medicine (DAME), University of Udine, Udine, Italy

    Marco Colizzi

  2. Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

    Mirella Ruggeri

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Rutigliano, G., Del Grande, C. (2022). Clinical Staging of Psychiatric Disorders: Its Utility in Mental Health Prevention. In: Colizzi, M., Ruggeri, M. (eds) Prevention in Mental Health . Springer, Cham. https://doi.org/10.1007/978-3-030-97906-5_2

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  • DOI: https://doi.org/10.1007/978-3-030-97906-5_2

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