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 articlepeer-review

29 Scopus citations


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 (US)
Pages (from-to)659-678
Number of pages20
JournalBipolar Disorders
Issue number7
Early online dateJun 26 2021
StatePublished - Jul 23 2021

Bibliographical note

Funding Information:
RK has received research support from the Stanley Foundation, ZonMw, and Astra‐Zeneca, and in the past received honoraria as speaker from AstraZeneca, Lundbeck, EliLilly, and Janssen, all for work unrelated to this manuscript. AD; has received research operating grants for the Canadian Institute for Health Research (165597, 152976). JS none. JA has received research support from Janssen Research Foundation and Otsuka Pharmaceutical Development & Commercialization, Inc., for work unrelated to this manuscript. VB‐M acknowledges the support from Instituto de Salud Carlos III (PI16/1770, PROBILIFE Study) and has been a consultant, advisor, or Continuing Medical Education (CME) speaker over the last 3 years for the following companies: Angelini; Ferrer; Lundbeck; Nutrición Médica; and Otsuka. BB none. DJB has received research support and/or honoraria from Alkermes PLC, the Isora Wells Foundation, Myriad Genetics, the National Institutes of Health, the University of Minnesota Department of Psychiatry and Behavioral Sciences, and the University of Minnesota Foundation for work unrelated to this manuscript. Dr. Brietzke has research grants from Queen's University (Department of Psychiatry and Centre for Neuroscience Studies, Harry Botterell Foundation for Neurological Sciences, the Dr. James B. Howe Endowment Fund, and Violet E. Powell Endowed Funds‐ Faculty of Health Sciences), South Eastern Ontario Medical Association (SEAMO), CNPq, FAPESP, CAPES, and from a L'Oreal for Women in Science Award. She also received honoraria as a speaker/advisory board member from Daiichi‐Sankyo and Janssen‐Cilag. IC none. BNF none. IG has received grants and served as consultant, advisor, or CME speaker for the following identities: Angelini, AstraZeneca, CasenRecordati, Ferrer, Janssen Cilag, and Lundbeck, Lundbeck‐Otsuka, SEI Healthcare, FEDER, Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017SGR1365), CERCA Programme/Generalitat de Catalunya, Spanish Ministry of Economy and Competitiveness, and Instituto de Salud Carlos III (PI16/00187, PI19/00954). Dr. Hafeman has received research funding from the National institutes of Mental Health and the Brain and Behavior Research Foundation. TH was supported by funding from the Canadian Institutes of Health Research (103703, 106469, and 142255), Nova Scotia Health Research Foundation, Dalhousie Clinical Research Scholarship to T. Hajek, Brain & Behavior Research Foundation (formerly NARSAD), and 2007 Young Investigator and 2015 Independent Investigator Awards MH has received grants from ZonMw (60‐63600‐98‐021), the Netherlands Organization for Scientific Research (NWO) (9120818), and Brain & Behavior Research Foundation (formerly NARSAD); 2013 Independent Investigator Award (20244). Marcia Kauer‐Sant’Anna none. Rodrigo B. Mansur none. Robert Post none. Afra van der Markt none. HT is supported by Australian Government Research Training Program Scholarship. Dr Tohen is a former full‐time employee at Lilly (1997 to 2008). He has been a consultant for AstraZeneca, Abbott, BMS, Lilly, GSK, J&J, Otsuka, Roche, Lundbeck, Elan, Alkermes, Allergan, Intracellular Therapies, Merck, Minerva, Neurocrine, Pamlab, Alexza, Forest, Teva, Sunovion, and Gedeon Richter. His spouse is a former employee at Lilly (1998–2013). GHV has served as speaker, consultant, or advisory board member for AbbVie, Allergan, Eurofarma, Elea‐Phoenix, Gador, Janssen Cilag, Raffo, Sunovion, and Otsuka/Lundbeck. EV thanks the support of the Spanish Ministry of Science and Innovation (PI15/00283, PI18/00805) integrated into the Plan Nacional de I+D+I and co‐financed by the ISCIII‐Subdirección General de Evaluación and the Fondo Europeo de Desarrollo Regional (FEDER); the Instituto de Salud Carlos III; the CIBER of Mental Health (CIBERSAM); the Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 1365); the CERCA Programme; and the Departament de Salut de la Generalitat de Catalunya for the PERIS grant SLT006/17/00357. LNY has been on speaker/advisory boards for, or has received research grants from, Abbvie, Alkermes, Allergan, CANMAT, CIHR, DSP, Merck, and Sanofi. MB is supported by a NHMRC Senior Principal Research Fellowship (1059660 and 1156072). MB has received Grant/Research Support from the NIH, Cooperative Research Centre, Simons Autism Foundation, Cancer Council of Victoria, Stanley Medical Research Foundation, Medical Benefits Fund, National Health and Medical Research Council, Medical Research Futures Fund, Beyond Blue, Rotary Health, A2 milk company, Meat and Livestock Board, Woolworths, Avant, and the Harry Windsor Foundation, has been a speaker for Astra Zeneca, Lundbeck, Merck, and Pfizer, and served as a consultant to Allergan, Astra Zeneca, Bioadvantex, Bionomics, Collaborative Medicinal Development, Lundbeck Merck, Pfizer, and Servier—all unrelated to this work. Martin Alda none. Flávio Kapczinski none.

Publisher Copyright:
© 2021 The Authors. Bipolar Disorders published by John Wiley & Sons Ltd.


  • bipolar disorders
  • clinical staging
  • nomenclature


Dive into the research topics of 'Consensus on nomenclature for clinical staging models in bipolar disorder: A narrative review from the International Society for Bipolar Disorders (ISBD) Staging Task Force'. Together they form a unique fingerprint.

Cite this