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Challenges Associated with Application of Clinical Staging Models to Psychotic Disorders

  • Daniel H. Mathalon
    Correspondence
    Address correspondence to Daniel H. Mathalon, Ph.D., M.D., Mental Health Service, 116d, San Francisco VA Medical Center, 4150 Clement St., San Francisco, California 94121
    Affiliations
    Department of Psychiatry, University of California, San Francisco; San Francisco Veterans Affairs Medical Center, San Francisco, California, and the Department of Psychiatry, Yale University, New Haven, Connecticut
    Search for articles by this author
      Previously, McGorry and colleagues (
      • McGorry P.D.
      • Hickie I.B.
      • Yung A.R.
      • Pantelis C.
      • Jackson H.J.
      Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions.
      ,
      • McGorry P.D.
      Issues for DSM-V: clinical staging: a heuristic pathway to valid nosology and safer, more effective treatment in psychiatry.
      ) proposed the application of clinical staging models to psychiatric disorders, with a focus on psychoses and severe mood disorders. In this issue, Wood et al. (
      • Wood S.J.
      • Yung A.R.
      • McGorry P.D.
      • Pantelis C.
      Neuroimaging and treatment evidence for clinical staging in psychotic disorders: from the at-risk mental state to chronic schizophrenia.
      ) expand on this staging model for psychotic disorders, using pathophysiological data and treatment response data to evaluate key predictions associated with a valid staging model (
      • Wood S.J.
      • Yung A.R.
      • McGorry P.D.
      • Pantelis C.
      Neuroimaging and treatment evidence for clinical staging in psychotic disorders: from the at-risk mental state to chronic schizophrenia.
      ). The staging model proposed uses clinical criteria to define illness severity stages that progress from relatively few, mild, and nonspecific symptoms to an increasing number of more severe symptoms, including psychotic symptoms, neurocognitive impairments, comorbid conditions, and functional decline, culminating in the persistent disabling symptoms of chronic schizophrenia. Each stage is associated with an elevated risk for progression to the next stage. Although some patients progress through all of the stages, progression is not considered inevitable.
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