Content area
Background
Diagnosis in psychiatry faces familiar challenges. Validity and utility remain elusive, and confusion regarding the fluid and arbitrary border between mental health and illness is increasing. The mainstream strategy has been conservative and iterative, retaining current nosology until something better emerges. However, this has led to stagnation. New conceptual frameworks are urgently required to catalyze a genuine paradigm shift.
Methods
We outline candidate strategies that could pave the way for such a paradigm shift. These include the Research Domain Criteria (RDoC), the Hierarchical Taxonomy of Psychopathology (HiTOP), and Clinical Staging, which all promote a blend of dimensional and categorical approaches.
Results
These alternative still heuristic transdiagnostic models provide varying levels of clinical and research utility. RDoC was intended to provide a framework to reorient research beyond the constraints of DSM. HiTOP began as a nosology derived from statistical methods and is now pursuing clinical utility. Clinical Staging aims to both expand the scope and refine the utility of diagnosis by the inclusion of the dimension of timing. None is yet fit for purpose. Yet they are relatively complementary, and it may be possible for them to operate as an ecosystem. Time will tell whether they have the capacity singly or jointly to deliver a paradigm shift.
Conclusions
Several heuristic models have been developed that separately or synergistically build infrastructure to enable new transdiagnostic research to define the structure, development, and mechanisms of mental disorders, to guide treatment and better meet the needs of patients, policymakers, and society.
Details
Medical diagnosis;
Stagnation;
Psychopathology;
Mental disorders;
Clinical research;
Policy making;
Diagnosis;
Statistical models;
Infrastructure;
Psychiatry;
Classification;
Problem solving;
Frame analysis;
Biomarkers;
Boundaries;
Mental health;
Candidates;
Cognitive ability;
Precision medicine;
Paradigms;
Confusion;
Grammatical aspect;
Research;
Models;
Statistical methods;
Patients;
Disorders;
Medical treatment
; Hickie, Ian B 2 ; Kotov, Roman 3 ; Schmaal, Lianne 1 ; Wood, Stephen J 4 ; Allan, Sophie M 5 ; Altınbaş, Kürşat 6 ; Boyce, Niall 7 ; Bringmann, Laura F 8 ; Caspi, Avshalom 9 ; Cuthbert, Bruce 10 ; Gawęda, Łukasz 11 ; Groen, Robin N 12 ; Guloksuz, Sinan 13 ; Hartmann, Jessica A 14 ; Krueger, Robert F 15 ; Mei, Cristina 1 ; Nieman, Dorien 16 ; Dost Öngür 17 ; Raballo, Andrea 18 ; Scheffer, Marten 19 ; Schreuder, Marieke J 12 ; Shah, Jai L 20 ; Wigman, Johanna T W 12 ; Hok Pan Yuen 1 ; Nelson, Barnaby 1 1 Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
2 Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
3 Department of Psychiatry, Stony Brook University, Stony Brook, New York, USA
4 Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; School of Psychology, University of Birmingham, Birmingham, UK
5 Norwich Medical School, University of East Anglia, Norwich, UK
6 Department of Psychiatry, Selcuk University Faculty of Medicine, Konya, Turkey
7 Wellcome, London, UK
8 Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands; Interdisciplinary Center of Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
9 Department of Psychology and Neuroscience, Duke University, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; Center for Genomic and Computational Biology, Duke University, Durham, NC, USA; Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK; PROMENTA Center, University of Oslo, Oslo, Norway
10 National Institute of Mental Health, Bethesda, MD, USA
11 Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
12 Interdisciplinary Center of Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
13 Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
14 Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
15 Department of Psychology, University of Minnesota, Minneapolis, MN, USA
16 Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, The Netherlands
17 Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA
18 Chair of Psychiatry, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland; Cantonal Socio-psychiatric Organization, Public Health Division, Department of Health and Social Care, Repubblica e Cantone Ticino, Mendrisio, Switzerland
19 Wageningen University, Wageningen, The Netherlands
20 Department of Psychiatry, McGill University, Montreal, QC, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, QC, Canada; ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, QC, Canada