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Chapter 5 - The Utility of Clinical Staging in Youth Mental Health Settings

Neurobiological and Longitudinal Data from Sydney-Based Studies of Transdiagnostic Cohorts

from Section 2 - Progress with Clinical Staging

Published online by Cambridge University Press:  08 August 2019

By
Ian B. Hickie ,
Joanne S. Carpenter ,
Frank Iorfino ,
Elizabeth Scott ,
Shane Cross  and
Daniel F. Hermens
Edited by
Patrick D. McGorry  and
Ian B. Hickie
Patrick D. McGorry
Affiliation:
University of Melbourne
Ian B. Hickie
Affiliation:
University of Sydney
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Summary

For over a decade a transdiagnostic clinical staging framework for youth with anxiety, mood and psychotic disorders (linked with measurement of multidimensional outcomes), has been utilised in over 8,000 young people presenting to the enhanced primary (headspace) and secondary care clinics of the Brain and Mind Centre of the University of Sydney. This framework has been evaluated alongside a broad range of other clinical, neurobiological, neuropsychological, brain imaging, circadian, metabolic, longitudinal cohort and controlled intervention studies. This has led to specific tests of its concurrent, discriminant and predictive validity. These extensive data provide strong preliminary evidence that: i) varying stages of illness are associated with predicted differences in a range of independent and objectively measured neuropsychological and other biomarkers (both cross-sectionally and longitudinally); and, ii) that earlier stages of illness progress at variable rates to later and more severe or persistent disorders. Importantly, approximately 15-20% of those young people classed as stage 1b or ‘attenuated’ syndromes at presentation progress to more severe or persistent disorders. Consequently, this cohort should be the focus of active secondary prevention trials. In clinical practice, we are moving to combine the staging framework with likely pathophysiological paths (e.g. neurodevelopmental-psychotic, anxiety-depression, circadian-bipolar) to underpin enhanced treatment selection.

Keywords

clinical stagingtransidagnositicmental disordersvalidityclinical utilityneurocognitionneuroimagingsleepcircadian
Type
Chapter
Information
Clinical Staging in Psychiatry
Making Diagnosis Work for Research and Treatment
 , pp. 81 - 102
Publisher: Cambridge University Press
Print publication year: 2019

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