Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force

Ralph Kupka, Anne Duffy, Jan Scott, Jorge Almeida, Vicent Balanzá-Martínez, Boris Birmaher, David J. Bond, Elisa Brietzke, Ines Chendo, Benicio N. Frey, Iria Grande, Danella Hafeman, Tomas Hajek, Manon Hillegers, Marcia Kauer-Sant’Anna, Rodrigo B. Mansur, Afra van der Markt, Robert Post, Mauricio Tohen, Hailey TremainGustavo Vazquez, Eduard Vieta, Lakshmi N. Yatham, Michael Berk, Martin Alda, Flávio Kapczinski

Research output: Contribution to journalReview articleAcademicpeer-review

21 Citations (Scopus)


Objectives: Clinical staging is widely used in medicine to map disease progression, inform prognosis, and guide treatment decisions; in psychiatry, however, staging remains a hypothetical construct. To facilitate future research in bipolar disorders (BD), a well-defined nomenclature is needed, especially since diagnosis is often imprecise with blurred boundaries, and a full understanding of pathophysiology is lacking. Methods: Under the auspices of the International Society of Bipolar Disorders, a Task Force of international experts was convened to review, discuss, and integrate findings from the scientific literature relevant to the development of a consensus staging model and standardize a terminology that could be used to advance future research including staging of BD and related disorders. Results: Consensus opinion and areas of uncertainty or difference were identified in regard to terms referring to staging as it may apply to BD, to at-risk status and subthreshold stages, and to various clinical stages of BD as it is currently diagnosed. Conclusion: The use of a standardized nomenclature about the clinical stages of BD will facilitate communication about research on clinical and pathological components of this heterogeneous group of disorders. The concepts presented are based on current evidence, but the template provided allows for further refinements as etiological advances come to light.
Original languageEnglish
Pages (from-to)659-678
Number of pages20
JournalBipolar disorders
Issue number7
Early online date2021
Publication statusPublished - Nov 2021


  • bipolar disorders
  • clinical staging
  • nomenclature

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