Clinical staging in psychiatry: a cross

Proposed staging model for psychotic and severe mood disorders

Stage	Definition of stage (psychosis or severe mood disorder)
0	Increased risk of psychotic or severe mood disorder. No symptoms currently.
Ia	Mild or non-specific symptoms (including subtle neurocognitive deficits) of psychosis or severe mood disorder. Mild functional change or decline.
Ib	Ultra-high risk: moderate but subthreshold symptoms, with neurocognitive changes and functional decline to caseness (GAF <70)
II	First episode of psychotic or severe mood disorder. Full threshold disorder with moderate to severe symptoms, neurocognitive deficits and functional decline (GAF 30–50).
IIIa	Incomplete remission from first episode of care. (Patient's management could be linked or fast-tracked to Stage IV.)
IIIb	Recurrence or relapse of psychotic or mood disorder which stabilises with treatment at a GAF level ≤30, or with residual symptoms or neurocognition below the best level achieved after remission from the first episode.
IIIc	Multiple relapses with worsening in clinical extent and impact of illness objectively present.
IV	Severe, persistent or unremitting illness as judged by symptoms, neurocognition and disability criteria.

GAF, Global Assessment of Functioning.

Adapted from McGorry et al.¹