The prospect of staging psychiatric disorders has been a source of ongoing controversy since the idea was first proposed in the early 1990s, based on the staging models used for cancer. More recently, several staging models have been proposed for bipolar disorder; however, as yet there is no consensus as to which model (or composite) is best, and there is no substantive evidence in support of any one of the models. The fundamental problem is that, unlike cancer, the pathophysiology of psychiatric disorders such as bipolar disorder is essentially unknown. The illness has many neurobiological underpinnings, but whether these are truly causal and if so how they lead to the illness, remains a mystery. As a consequence, there is no way of predicting when the illness will emerge and what trajectory it will take. Its response to treatment and prognosis is equally unpredictable, and therefore, models attempting to stage the disorder on the basis of clinical markers have limited utility. This is especially so, because the clinical presentation of bipolar disorder is particularly complex as it often occurs in the context of comorbidities, which further obscure the clinical picture. Therefore, in this QuiP, we provide insights as to why current methods of staging bipolar disorder are hamstrung and propose a way forward that may yield meaningful insights.

中文翻译：

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精神病学问题 (QuiP)：分期双相情感障碍可能吗？如果是这样，从哪里开始？

自从 1990 年代初期根据用于癌症的分期模型首次提出该想法以来，对精神疾病进行分期的前景一直存在争议。最近，已经提出了几种双相情感障碍的分期模型；然而，对于哪种模型（或组合）最好尚未达成共识，也没有实质性证据支持任何一种模型。根本问题在于，与癌症不同，双相情感障碍等精神障碍的病理生理学本质上是未知的。这种疾病有许多神经生物学基础，但这些是否真的是因果关系，如果是，它们是如何导致这种疾病的，仍然是个谜。因此，无法预测疾病何时会出现以及它将采取什么样的轨迹。它对治疗和预后的反应同样不可预测，因此，试图根据临床标志物对疾病进行分期的模型的效用有限。尤其如此，因为双相情感障碍的临床表现特别复杂，因为它经常发生在合并症的背景下，这进一步模糊了临床表现。因此，在这个 QuiP 中，我们提供了有关为什么当前的双相情感障碍分期方法受到阻碍的见解，并提出了可能产生有意义见解的前进方向。这进一步模糊了临床情况。因此，在这个 QuiP 中，我们提供了有关为什么当前的双相情感障碍分期方法受到阻碍的见解，并提出了可能产生有意义见解的前进方向。这进一步模糊了临床情况。因此，在这个 QuiP 中，我们提供了有关为什么目前分期双相情感障碍的方法受到阻碍的见解，并提出了可能产生有意义见解的前进方向。