Clarke Sharon L, Soons Nicole, Videler Arjan C, van Alphen Sebastiaan P J, Van Henricus, Dil Linda, Pappijn Laurens, Corbeij Sven, Broekhof Beau, Chanen Andrew M, Hutsebaut Joost
Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands.
Viersprong Institute for Studies on Personality Disorders, De Viersprong, Halsteren, Netherlands.
Front Psychiatry. 2025 Jan 15;15:1473051. doi: 10.3389/fpsyt.2024.1473051. eCollection 2024.
Clinical staging aims to refine psychiatric diagnosis by describing mental disorders on a continuum of disorder progression, with the pragmatic goal of improved treatment planning and outcome prediction. The first systematic review on this topic, published a decade ago, included 78 papers, and identified separate staging models for schizophrenia, unipolar depression, bipolar disorder, panic disorder, substance use disorder, anorexia, and bulimia nervosa. The current review updates this review by including new proposals for staging models and by systematically reviewing research based upon full or partial staging models since 2012.
PsycINFO, MEDLINE, EMBASE, and the Cochrane databases were systematically searched from 2012 to June 2023. The original review's eligibility criteria were used and extended with newly introduced categories of DSM-5 mental disorders, along with mental disorders for which a progressive course might be expected. Included papers: a) contained a complete or partial staging model, or b) focused upon clinical features that might be associated with stages, or c) focused upon treatment research associated with specific stages.
Seventy-one publications met the inclusion criteria. They described staging models for schizophrenia and related psychoses (21 papers), bipolar (20), depressive (4), anxiety (2), obsessive-compulsive (3), trauma related (4), eating (3), personality disorders (2), and 'transdiagnostic' staging models (13).
There is a steady but slow increase in interest in clinical staging and evidence for the validity of staging remains scarce. Staging models might need to be better tailored to the complexities of mental disorders to improve their clinical utility.
https://www.crd.york.ac.uk/prospero/, identifier CRD42021291703.
临床分期旨在通过在疾病进展的连续体上描述精神障碍来完善精神科诊断，其实际目标是改善治疗计划和结果预测。十年前发表的关于该主题的首次系统评价纳入了78篇论文，并确定了精神分裂症、单相抑郁症、双相情感障碍、惊恐障碍、物质使用障碍、厌食症和神经性贪食症的单独分期模型。本综述通过纳入分期模型的新提议以及系统回顾自2012年以来基于完整或部分分期模型的研究来更新该综述。
对2012年至2023年6月的PsycINFO、MEDLINE、EMBASE和Cochrane数据库进行系统检索。使用了原始综述的纳入标准，并扩展了新引入的DSM-5精神障碍类别以及可能预期有渐进病程的精神障碍。纳入的论文：a)包含完整或部分分期模型，或b)关注可能与阶段相关的临床特征，或c)关注与特定阶段相关的治疗研究。
71篇出版物符合纳入标准。它们描述了精神分裂症及相关精神病（21篇论文）、双相情感障碍（20篇）、抑郁症（4篇）、焦虑症（2篇）、强迫症（3篇）、创伤相关疾病（4篇）、饮食障碍（3篇）、人格障碍（2篇）和“跨诊断”分期模型（13篇）的分期模型。
对临床分期的兴趣稳步但缓慢增加，分期有效性的证据仍然稀少。分期模型可能需要更好地适应精神障碍的复杂性，以提高其临床实用性。
