Cumulative morbidity and prognostic staging of illness in the systematic treatment enhancement program for Bipolar Disorder (STEP-BD)

Magalhaes, Pedro Vieira, Dodd, Seetal, Nierenberg, Andrew A. and Berk, Michael 2012, Cumulative morbidity and prognostic staging of illness in the systematic treatment enhancement program for Bipolar Disorder (STEP-BD), Australian and New Zealand journal of psychiatry, vol. 46, no. 11, pp. 1058-1067, doi: 10.1177/0004867412460593.

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Title Cumulative morbidity and prognostic staging of illness in the systematic treatment enhancement program for Bipolar Disorder (STEP-BD)
Author(s) Magalhaes, Pedro Vieira
Dodd, SeetalORCID iD for Dodd, Seetal
Nierenberg, Andrew A.
Berk, MichaelORCID iD for Berk, Michael
Journal name Australian and New Zealand journal of psychiatry
Volume number 46
Issue number 11
Start page 1058
End page 1067
Total pages 10
Publisher Sage Publications Ltd
Place of publication London, England
Publication date 2012-11
ISSN 0004-8674
Keyword(s) bipolar disorder
cumulative morbidity
Summary Objective: Staging models may provide heuristic utility for intervention selection in psychiatry. Although a few proposals have been put forth, there is a need for empirical validation if they are to be adopted. Using data from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), we tested a previously elaborated hypothesis on the utility of using the number of previous episodes as a relevant prognostic variable for staging in bipolar disorder.

This report utilizes data from the multisite, prospective, open-label study ‘Standard Care Pathways’ and the subset of patients with acute depressive episodes who participated in the randomized trial of adjunctive antidepressant treatment. Outpatients meeting DSM-IV diagnostic criteria for bipolar disorder (n = 3345) were included. For the randomized pathway, patients met criteria for an acute depressive episode (n = 376). The number of previous episodes was categorized as less than 5, 5–10 and more than 10. We used disability at baseline, number of days well in the first year and longitudinal scores of depressive and manic symptoms, quality of life and functioning as validators of models constructed a priori.

Results: Patients with multiple previous episodes had consistently poorer cross-sectional and prospective outcomes. Functioning and quality of life were worse, disability more common, and symptoms more chronic and severe. There was no significant effect for staging with regard to antidepressant response in the randomized trial.

Conclusions: These findings confirm that bipolar disorder can be staged with prognostic validity. Stages can be used to stratify subjects in clinical trials and develop specific treatments.
Language eng
DOI 10.1177/0004867412460593
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2012, Sage publishers
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Document type: Journal Article
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