Globally, 75% of depressive, bipolar, and psychotic disorders emerge by age 25 years. However, these disorders are often preceded by non-specific symptoms or attenuated clinical syndromes. Difficulties in determining optimal treatment interventions for these emerging mental disorders, and uncertainties about accounting for co-occurring psychopathology and illness trajectories, have led many youth mental health services to adopt transdiagnostic clinical staging frameworks. In this Health Policy paper, an international working group highlights ongoing challenges in applying transdiagnostic staging frameworks in clinical research and practice, and proposes refinements to the transdiagnostic model to enhance its reliability, consistent recording, and clinical utility. We introduce the concept of within-stage heterogeneity and describe the advantages of defining stage in terms of clinical psychopathology and stage modifiers. Using examples from medicine, we discuss the utility of categorising stage modifiers into factors associated with progression (ie, potential predictors of stage transition) and extension (ie, factors associated with the current presentation that add complexity to treatment selection). Lastly, we suggest how it is possible to revise the currently used transdiagnostic staging approach to incorporate these key concepts, and how the revised framework could be applied in clinical and research practice.

中文翻译：

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分期 2.0：完善跨诊断临床分期框架，以提高青少年心理健康的可靠性和实用性


全球范围内，75% 的抑郁症、躁郁症和精神障碍在 25 岁时出现。然而，这些疾病之前通常会出现非特异性症状或减弱的临床综合征。由于难以确定针对这些新出现的精神障碍的最佳治疗干预措施，以及对同时发生的精神病理学和疾病轨迹的解释的不确定性，导致许多青少年心理健康服务机构采用跨诊断临床分期框架。在这份卫生政策论文中，一个国际工作组强调了在临床研究和实践中应用跨诊断分期框架所面临的持续挑战，并提出了对跨诊断模型的改进，以提高其可靠性、一致记录和临床实用性。我们引入了阶段内异质性的概念，并描述了根据临床精神病理学和阶段修饰符定义阶段的优点。使用医学中的例子，我们讨论了将阶段修饰因素分类为与进展相关的因素（即阶段转变的潜在预测因素）和扩展（即与当前表现相关的因素，增加了治疗选择的复杂性）的实用性。最后，我们建议如何修改当前使用的跨诊断分期方法以纳入这些关键概念，以及如何将修订后的框架应用于临床和研究实践。