Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions
Article first published online: 11 DEC 2006
Australian and New Zealand Journal of Psychiatry
Volume 40, Issue 8, pages 616–622, August 2006
How to Cite
McGorry, P. D., Hickie, I. B., Yung, A. R., Pantelis, C. and Jackson, H. J. (2006), Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Australian and New Zealand Journal of Psychiatry, 40: 616–622. doi: 10.1111/j.1440-1614.2006.01860.x
- Issue published online: 11 DEC 2006
- Article first published online: 11 DEC 2006
- Received 31 January 2006; accepted 1 February 2006.
- early intervention;
Diagnosis in psychiatry increasingly struggles to fulfil its key purposes, namely, to guide treatment and to predict outcome. The clinical staging model, widely used in clinical medicine yet virtually ignored in psychiatry, is proposed as a more refined form of diagnosis which could restore the utility of diagnosis, promote early intervention and also make more sense of the confusing array of biological research findings in psychiatry by organizing data into a coherent clinicopathological framework. A selective review of key papers in clinical medicine and psychiatry which describe clinical and clinicopathological staging, and a range of related issues. Clinical staging has immediate potential to improve the logic and timing of interventions in psychiatry just as it does in many complex and potentially serious medical disorders. Interventions could be evaluated in terms of their ability to prevent or delay progression from earlier to later stages of disorder, and they could be selected on clear-cut risk/benefit criteria. Biological variables and a range of candidate risk factors could be studied within and across stages, and their role, specificity and centrality in risk, onset and progression of disorder could be greatly clarified. A clinicopathological framework could be progressively constructed. Clinical staging with a restructure across and within diagnostic boundaries with the explicit operationalization of criteria for extent and progression of disorder should be actively explored in psychiatry as a heuristic strategy for the development and evaluation of earlier, safer, and more effective clinical interventions, and for clarifying the biological basis of psychiatric disorders.