Towards an Integrated Staging Model for Bipolar Disorders: An International Society for Bipolar Disorders ( <scp>ISBD</scp> ) Staging Task Force Consensus Report

OBJECTIVES: Three clinical staging models for bipolar disorder (BD) have been published, each with a different but complementary approach and focus. The International Society for Bipolar Disorders Staging Task Force aimed to integrate these models into one comprehensive three-dimensional staging model, separately rating bipolar spectrum, nonmood psychopathology, and (inter-episodic) functional impairment. METHOD: Via a series of in-person and online meetings, Delphi-surveys, and email discussions, the task force members step-by-step reached consensus on the overall structure of the model and the definition of the various stages. RESULTS: The resulting BD staging model describes the progression of mood psychopathology, nonmood psychopathology, and functional impairment in three independently rated dimensions. The stages of the mood psychopathology are M0 (at risk for BD having a 1st or 2nd degree family member with BD); M1 (prodromal); M2 (first episode classifying for BD-I or BD-II); M3 (recurrent BD); and M4 (chronic unremitting BD), with various substages. Single or recurrent major depression in persons at familial risk for BD is positioned in stage M1. The stages for nonmood psychopathology are: N0 (no symptoms); N1 (subsyndromal symptoms); N2 (one nonmood disorder); N3 (two nonmood disorders); N4 (three or more nonmood disorders). The stages for functional impairment are: F0 (no); F1 (mild); F2 (moderate); F3 (marked); and F4 (severe impairment). Fictitious case vignettes are presented to demonstrate how to apply the model. Limitations of clinical staging are discussed. CONCLUSION: The proposed three-dimensional clinical staging model for illness progression comprehensively captures the complexity of illness presentation and heterogeneous illness progression in BD, including psychiatric comorbidities and degree of functional impairment. The model provides a framework that requires validation in research and clinical practice.

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Journal
Bipolar Disorders
Published
2026-06-17
DOI
https://doi.org/10.1111/bdi.70136
Primary Topic
Bipolar Disorder and Treatment
Type
article
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article

Towards an Integrated Staging Model for Bipolar Disorders: An International Society for Bipolar Disorders ( ISBD ) Staging Task Force Consensus Report

Madeleine McCallum, Mauricio Tohen, Ralph Kupka, Danella Hafeman et al.
Bipolar Disorders
Bipolar Disorder and Treatment
article

Towards an Integrated Staging Model for Bipolar Disorders: An International Society for Bipolar Disorders ( ISBD ) Staging Task Force Consensus Report

Madeleine McCallum, Mauricio Tohen, Ralph Kupka, Danella Hafeman, Tomáš Hájek, Anne Cecilia Duffy, Inês Chendo, David J. Bond, Hailey Tremain, Manon H. J. Hillegers, Taiane de Azevedo Cardoso, Vicent Balanzá‐Martínez, Gustavo Vázquez, Ives Cavalcante Passos, Robert M. Post, Iría Grande, Eduard Vieta, Afra van der Markt, M Guadalupe Alda, Elisa Brietzke, Michael Berk, Márcia Kauer-Sant'Anna, Flávio Kapczinski, Rodrigo Mansur, Jorge Almeida, Ana Gonzalez Pinto, Boris Birmaher, Lakshmi N. Yatham
article en

Abstract

OBJECTIVES: Three clinical staging models for bipolar disorder (BD) have been published, each with a different but complementary approach and focus. The International Society for Bipolar Disorders Staging Task Force aimed to integrate these models into one comprehensive three-dimensional staging model, separately rating bipolar spectrum, nonmood psychopathology, and (inter-episodic) functional impairment. METHOD: Via a series of in-person and online meetings, Delphi-surveys, and email discussions, the task force members step-by-step reached consensus on the overall structure of the model and the definition of the various stages. RESULTS: The resulting BD staging model describes the progression of mood psychopathology, nonmood psychopathology, and functional impairment in three independently rated dimensions. The stages of the mood psychopathology are M0 (at risk for BD having a 1st or 2nd degree family member with BD); M1 (prodromal); M2 (first episode classifying for BD-I or BD-II); M3 (recurrent BD); and M4 (chronic unremitting BD), with various substages. Single or recurrent major depression in persons at familial risk for BD is positioned in stage M1. The stages for nonmood psychopathology are: N0 (no symptoms); N1 (subsyndromal symptoms); N2 (one nonmood disorder); N3 (two nonmood disorders); N4 (three or more nonmood disorders). The stages for functional impairment are: F0 (no); F1 (mild); F2 (moderate); F3 (marked); and F4 (severe impairment). Fictitious case vignettes are presented to demonstrate how to apply the model. Limitations of clinical staging are discussed. CONCLUSION: The proposed three-dimensional clinical staging model for illness progression comprehensively captures the complexity of illness presentation and heterogeneous illness progression in BD, including psychiatric comorbidities and degree of functional impairment. The model provides a framework that requires validation in research and clinical practice.

Bipolar DisordersVol. 28(5)
Dalhousie University (CA), Universidade Federal do Rio Grande do Sul (BR), Barwon Health (AU), University Health Network (CA), University of Lisbon (PT), University of British Columbia (CA), Johns Hopkins University (US), Deakin University (AU), The University of Melbourne (AU), University of the Basque Country (ES), University of New Mexico (US), University of Pittsburgh (US), University of Toronto (CA), George Washington University (US), Queen's University (CA), Florey Institute of Neuroscience and Mental Health (AU), Johns Hopkins Medicine (US), Instituto de Salud Carlos III (ES), University of Oxford (GB), Centro de Investigación Biomédica en Red de Salud Mental (ES), Hospital Clínico Universitario de Valencia (ES), Departament de Salut (ES), Hospital de Clínicas de Porto Alegre (BR), Orygen (AU), Hospital Clínic de Barcelona (ES), Collaborative Group (United States) (US), University of Pittsburgh Medical Center (US), Erasmus MC - Sophia Children’s Hospital (NL), Hospital de Santa Maria (PT), INCLIVA Health Research Institute (ES), Consorci Institut D'Investigacions Biomediques August Pi I Sunyer (ES), Swinburne University of Technology (AU), St. Joseph’s Healthcare Hamilton (CA), Universitat de Barcelona (ES), The University of Texas at Austin (US), Vrije Universiteit Amsterdam (NL)
Openalex Percentile: Top 6%
Bipolar Disorder and Treatment
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