Table 2.
Staging modela
| Stage 0 | Increased risk (as defined by a 1st degree relative with bipolar disorder); no psychiatric symptoms |
| Stage 1 | Non‐specific psychiatric symptoms or depressive episode(s) |
| A | Increased risk and non‐specific psychiatric symptoms, no history of depressive episode(s) |
| B | Increased risk and bipolar‐specific prodromal symptoms, no history of depressive episode(s) |
| C | Increased risk, with a first major depressive episode |
| D | Increased risk, with recurrent major depressive episodes |
| Stage 2 | First episode that qualifies for diagnosis of bipolar disorder |
| A | First manic episode (diagnosis BP‐I) without previous history of depressive episode(s) and without depression immediately preceding or following the first manic episode |
| B | First hypomanic (diagnosis BP‐II) or manic episode (diagnosis BP‐I) without previous history of depressive episode(s) but with depression immediately preceding or following first (hypo)manic episode |
| C | First hypomanic (diagnosis BP‐II) or manic episode (dx BP‐I) with previous history of depressive episode(s), with or without depression immediately preceding or following first (hypo)manic episode |
| D | First depression after hypomanic episode (diagnosis BP‐II) |
| Stage 3 | Recurrence of any depressive, hypomanic, or manic/mixed episode |
| A | Recurrence of subsyndromal depressive or manic symptoms after the diagnosis of bipolar disorder |
| B | Recurrent bipolar disorder (recurrence of any depressive, hypomanic, or manic/mixed episode) and with full symptomatic and functional recovery between episodes |
| C | Recurrent bipolar disorder (recurrence of any depressive, hypomanic, or manic/mixed episode), with subsyndromal symptoms and/or impaired functioning between episodes |
| Stage 4 | Persistent unremitting illness; chronic (>2 years) depressive, manic or mixed episodes, including rapid cycling |
| A | Chronic depressive, manic or mixed episode(s), without symptomatic and functional recovery for 2 years |
| B | Rapid cycling (≥4 mood episodes/year), without symptomatic and functional recovery for 2 years |
a
By Kupka & Hillegers (8), based on Berk et al.(6), Kapczinski et al.(33) and Duffy et al. (9).