CLASSIFICATION in PSYCHIATRY: from a SYMPTOM BASED to a CAUSE BASED MODEL? Dylan Pritchard Clare College Cambridge, Cambridge, UK

Total Page:16

File Type:pdf, Size:1020Kb

CLASSIFICATION in PSYCHIATRY: from a SYMPTOM BASED to a CAUSE BASED MODEL? Dylan Pritchard Clare College Cambridge, Cambridge, UK Psychiatria Danubina, 2015; Vol. 27, Suppl. 1, pp 7–20 Conference paper © Medicinska naklada - Zagreb, Croatia CLASSIFICATION IN PSYCHIATRY: FROM A SYMPTOM BASED TO A CAUSE BASED MODEL? Dylan Pritchard Clare College Cambridge, Cambridge, UK SUMMARY The assumption that eventually the classification in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) will incorporate aspects of causation uncovered by research in neuroscience is examined in view of the National Institute of Mental Health’s NIMH Research Domain Criteria (RDoC) project. I argue that significant advantages of maintaining the classification system, focussed on grouped descriptions of symptoms, are often undervalued or not considered. In this paper I will challenge the standard view that the transition from the purely symptom based approach is an inevitable and desirable change. Key words: classification – symptoms - mental illnesses - biomarkers * * * * * INTRODUCTION logies are still in their infancy, it is apparent that they have worth when it comes to identifying linkages bet- A standard view exists in much of psychiatry that ween the physical brain and mental disorders. More new classification in the American Psychiatric Association’s insights are occurring at the biochemical level with Diagnostic and Statistical Manual of Mental Disorders alterations in neurotransmitter composition being shown (DSM) will incorporate aspects of causation uncovered to be strongly linked with various mental disorders, by research in neuroscience. Currently the DSM aims to such as dopamine with the positive symptoms of schizo- minimise the influence of notions of causation and phrenia (Seeman 2011). These findings suggest to some aetiology, omitting any deeper theoretical underpinning. that molecules can be the cause of a disease. A third Arguments in favour of the standard view focus on two level for many researchers is genetics. With the increa- main factors, first of all that the introduction of sing ease with which a genome can be sequenced and causation is necessary to ensure classification is stable large scale genomic analyses, genetic and genomic and “carving nature at its joints” (Regier 2009), and se- linkages to mental disorder are being demonstrated. condly that future research will empirically demonstrate Huntington’s disease is the prime example of this as the that adding aetiology into classification will bring ad- HD gene has been shown to be the necessary and suffi- vantages in treatment. Much of the literature addresses cient cause of the disease (Walker 2007). Accordingly, when and how such a shift to include causes in classi- the introduction of new techniques for visualising the fication will occur. Significant advantages of main- living brain coupled with subsequent findings sugges- taining the classification system, focussed on grouped ting causal linkages, have brought forward the debate descriptions of symptoms, are often undervalued or not around the consequences of such research for psychia- considered. In this paper I will challenge the standard tric classification. view that the transition from the purely symptom based These advances have led many prominent figures in approach is an inevitable and desirable change. psychiatry to advocate an increased role for such Calls for such a shift are common in the field of physical causal theories in the DSM. Nancy Andreason, psychiatry. There is a desire for an alteration in the as a member of the task force for the development of underpinnings of the DSM to more closely reflect the DSM-III, and DSM-IV in an editorial of the American new research being conducted into the linkages between Journal of Psychiatry suggests that, “psychiatry is not mental disorder and physical processes within the brain. only founded on diagnoses that are validated by clinical The calls for a change are largely driven by recent description and epidemiological criteria, but it is technological advances in neuroscience. One of the challenged by the opportunity to probe more deeply into levels this is occurring at is advances in analysing brain mechanisms and perhaps to reach very fundamental structure, with the increased use of computerised tomo- levels of knowledge about etiology that will have graphy (CT) scanning and functional magnetic reso- profound implications” (Andreason 1995). In a piece by nance imaging technology (fMRI) to visualise the the chairs of the committee developing the most recent structure of the brain in living patients. These techno- DSM (DSM-5) (American Psychiatric Association logies have allowed researchers to visualise the brains 2013), the belief in an eventual move towards an of people with mental disorders such as in schizophrenia aetiologically based classification is again stressed with and find significant differences when compared to a focus on investigating, “how advances in neuroscience healthy individuals (Wright 2000). Whilst these techno- and behavioural science over the past two decades have S7 Dylan Pritchard: CLASSIFICATION IN PSYCHIATRY: FROM A SYMPTOM BASED TO A CAUSE BASED MODEL? Psychiatria Danubina, 2015; Vol. 27, Suppl. 1, pp 7–20 both increased our knowledge of etiologies and widened to less radical versions such as that of Dominic Murphy the gaps in our existing diagnostic system. A primary which allow disorders to be defined by causes on a goal for revising DSM-5, then, is to more fully variety of levels from the genetic and biomolecular incorporate research from the past two decades in an through to the psychological and social. The common attempt to build an empirical foundation” (Kupfer theme is that research evidence from studies in sub- 2008). The chairs of the DSM-5 committee in their disciplines of neuroscience will eventually prove too summary of the continuing evolution of the DSM significant to be ignored. As these views are projections emphasised the importance of advances in neuroscience into the future there is little consensus on what this prioritising, “The opportunity to evaluate the readiness would entail for the current mental disorders in DSM-5. of neuroscientific advances in pathophysiology, gene- Research may radically shift, or simply reaffirm the tics, pharmacogenomics, structural and functional current classes in psychiatry. The consensus amongst imaging, and neuropsychology” (Kupfer 2008). There is the proponents of a role for neuroscientific theory in a clear assumption within psychiatry that classification classification is that the classification systems of mental based on description alone is simply waiting to be disorders will define disorders using underlying causes. superseded by what is seen as an inherently superior The justifications for this approach revolve around system incorporating aetiology to produce its defini- two key arguments. The broader philosophical argument tions. However, I contend that when the potential advan- states that classifications based purely on symptoms are tages of cause based classifications are weighed against misguided as they are not representing an aspect of the the oft overlooked benefits of the description based nature of mental disorders. Neuroscience holds that system, it becomes clear that the description based mental disorders are products of the brain and classi- model is the superior option for classifying the majority fication should reflect this by including some references of mental disorders. to structure and theory linking structure to disorder. More confidence could be had in the disorder categories BACKGROUND if they could be shown to reflect distinct causal processes. This would lead to classifications which Current classification in psychiatry is based on des- would be more stable over time, in the sense that they cription of symptoms, the descriptive or atheoretical would be less prone to changing across the editions of approach. It aims to reduce the involvement of causes, the DSM. Treatment of mental disorders would be an approach enshrined in the DSM since the third improved if the categories were made more stable in edition in 1980. For instance, the previous second edi- this way as the targets for treatments would be less tion of DSM had included the neuroses as one of its prone to change. The second argument arising from this nine major diagnostic groups” (Kupfer 2008). These is that achieving a classification based on causes of were explicitly defined in the causal terms of psycho- disorders would result in improved treatments available analytic theory as an anxiety which was, “felt or expres- to patients acting at the level of the causes of disease. It sed directly, or ... may be controlled unconsciously and is assumed that studying causation in neuroscience automatically by conversion, displacement and various would lead to the development of new treatments acting other psychological mechanisms” (American Psychia- at the causal level. By classifying disease with reference tric Association 1968). The notion of causation was to its neuroscientific causes, such new interventions included in the core definition of what the disorder was would be optimally targeted, improving the treatment of with the reference to various psychological mechanisms patients. The advantages of a more accurate represen- which caused the manifestation of symptoms. The third, tation of the nature of mental disorders and conse- fourth and fifth editions, with their atheoretical aims, quently the development of treatments acting at these classify very differently.
Recommended publications
  • Biological Boundaries Between Bipolar I Disorder, Schizoaffective Disorder, and Schizophrenia Victoria E Cosgrove1,2 and Trisha Suppes1,2*
    Cosgrove and Suppes BMC Medicine 2013, 11:127 http://www.biomedcentral.com/1741-7015/11/127 $VSSFOU$POUSPWFSTJFTJO1TZDIJBUSZ DEBATE Open Access Informing DSM-5: biological boundaries between bipolar I disorder, schizoaffective disorder, and schizophrenia Victoria E Cosgrove1,2 and Trisha Suppes1,2* Abstract Background: The fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) opted to retain existing diagnostic boundaries between bipolar I disorder, schizoaffective disorder, and schizophrenia. The debate preceding this decision focused on understanding the biologic basis of these major mental illnesses. Evidence from genetics, neuroscience, and pharmacotherapeutics informed the DSM-5 development process. The following discussion will emphasize some of the key factors at the forefront of the debate. Discussion: Family studies suggest a clear genetic link between bipolar I disorder, schizoaffective disorder, and schizophrenia. However, large-scale genome-wide association studies have not been successful in identifying susceptibility genes that make substantial etiological contributions. Boundaries between psychotic disorders are not further clarified by looking at brain morphology. The fact that symptoms of bipolar I disorder, but not schizophrenia, are often responsive to medications such as lithium and other anticonvulsants must be interpreted within a larger framework of biological research. Summary: For DSM-5, existing nosological boundaries between bipolar I disorder and schizophrenia were retained and schizoaffective disorder preserved as an independent diagnosis since the biological data are not yet compelling enough to justify a move to a more neurodevelopmentally continuous model of psychosis. Keywords: Bipolar disorder, Hallucinations, Delusions, Schizoaffective disorder, Schizophrenia, DSM- 5, Genes, Psychiatric medication, Brain function Background distinguishing psychotic disorders [2] and, more broadly, Development of the fifth version of the Diagnostic and all psychiatric disorders [3-5].
    [Show full text]
  • DSM-5 and Rdoc: Shared Interests
    For Information Contact: Eve Herold, 703-907-8640 May 14, 2013 [email protected] Release No. 13-37 Erin Connors, 703-907-8562 [email protected] DSM-5 and RDoC: Shared Interests Thomas R. Insel, M.D., director, NIMH Jeffrey A. Lieberman, M.D., president-elect, APA NIMH and APA have a shared interest in ensuring that patients and health providers have the best available tools and information today to identify and treat mental health issues, while we continue to invest in improving and advancing mental disorder diagnostics for the future. Today, the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), along with the International Classification of Diseases (ICD) represents the best information currently available for clinical diagnosis of mental disorders. Patients, families, and insurers can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care. The National Institute of Mental Health (NIMH) has not changed its position on DSM-5. As NIMH’s Research Domain Criteria (RDoC) project website states, “The diagnostic categories represented in the DSM-IV and the International Classification of Diseases-10 (ICD-10, containing virtually identical disorder codes) remain the contemporary consensus standard for how mental disorders are diagnosed and treated.” Yet, what may be realistically feasible today for practitioners is no longer sufficient for researchers. Looking forward, laying the groundwork for a future diagnostic system that more directly reflects modern brain science will require openness to rethinking traditional categories. It is increasingly evident that mental illness will be best understood as disorders of brain structure and function that implicate specific domains of cognition, emotion, and behavior.
    [Show full text]
  • DSM-5 and Psychotic and Mood Disorders
    SPECIAL SECTION DSM-5 and Psychotic and Mood Disorders George F. Parker, MD The criteria for the major psychotic disorders and mood disorders are largely unchanged in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), with a few important exceptions: a new assessment tool for the psychotic disorders based on dimensional assessment, a new scheme of specifiers for the mood disorders, the addition of three new depressive disorders, and recognition of catatonia as a separate clinical entity. In addition, subtle changes to the diagnostic criteria for longstanding disorders may have important ramifications. There are forensic implications to these changes in the psychotic and mood disorders, but in most cases, these implications should be relatively modest, as the DSM-5 Work Groups ultimately adopted a cautious approach to changes in the psychotic and mood disorders. J Am Acad Psychiatry Law 42:182–90, 2014 This article will consider the forensic implications of forensic evaluations, but may be pertinent to compe- the changes in the diagnostic criteria for the psy- tence-to-stand-trial and insanity evaluations. They chotic and mood disorders contained in the Diag- are more common in civil forensic evaluations, par- nostic and Statistical Manual of Mental Disorders, ticularly in disability evaluations. Fifth Edition (DSM-5),1 which was published by the The members of the DSM-5 Task Force and American Psychiatric Association (APA) in May Work Groups reviewed the results of the abundant 2013. DSM-5 includes modest changes to the crite- neuroscience research published over the past two ria and descriptive text for nearly every psychotic and decades and realized that “the boundaries between mood disorder, some more significant than others.
    [Show full text]
  • Rdoc in HISTORICAL PERSPECTIVE Redefining Mental Illness by Tanya M
    1 Collated February 9, 2017 Conflict of Interest in Neuropsychopharmacology: Marketing vs. Education Thomas A. Ban THOMAS A. BAN: RDoC IN HISTORICAL PERSPECTIVE Redefining Mental Illness by Tanya M. Luhrmann. Samuel Gershon’s qestion Collated Document Olaf Fjetland This collated document includes Thomas A. Ban’s essay, “RDoC in Historical Perspective,” posted on February 19, 2015, and includes a critical question by Samuel Gershon regarding the RDoC and the other exchanges that followed the posting of this essay. Six participants exchanged a total of nine postings, including three postings by Samuel Gershom (of which one was incorporated in Ban’s essay), two postings by Thomas A. Ban, and one posting each by Bernard Carroll, Jose de Leon, Martin M. Katz and Antonio Nardi. The last entry in this exchange was made on October 1, 2015. This collated document is now open to all INHN members for final comment. Thomas Ban February 19, 2015 essay Samuel Gershon February 19, 2015 question on RDoC incorporated in Ban’s essay Bernard Carroll March 5, 2015 reply Samuel Gershon’s question Thomas A. Ban October 1, 2015 comment on Carroll’s answer to Gershon’s question Samuel Gershon March 12, 2015 response to Carroll’s reply Martin Katz March 19, 2015 comment on RDoC Antonio E. Nardi March 26, 2015 comment on RDoC Samuel Gershon May 21, 2015 reply to Martin Katz and Antonio Nardi’s comment Jose de Leon April 30, 2015 comment on RDoC RDoC IN HISTORICAL PERSPECTIVE Redefining Mental Illness by Tanya M. Luhrmann. Samuel Gershon’s qestion Thomas A. Ban In her article, “Redefining Mental Illness”, published in the Sunday Review of New York Times on January 17, 2015 (http://www.nytimes.com/2015/01/18/opinion/sunday/t-m-luhrmann- redefining-mental-illness.html?_r=0), Tanya Luhrmann wrote that in 2013, Thomas R.
    [Show full text]
  • The NIMH Rdoc Initiative: What Does It Mean for Psychiatric Nosology?
    The NIMH RDoC Initiative: What Does it Mean for Psychiatric Nosology? Thomas McCoy, MD www.mghcme.org Disclosures Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose. www.mghcme.org April 29, 2013 In a few weeks, the APA will release its new edition of the DSM. ... Symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. ... Patients with mental disorders deserve better. ... Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml www.mghcme.org April 29, 2013 In a few weeks, the APA will release its new Context edition of the DSM. ... Symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment. ... Patients with mental disorders deserve better. ... Going forward, we will be supporting research projects that look across current categories – or sub-divide current categories – to begin to develop a better system. https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml www.mghcme.org April 29, 2013 In a few weeks, the APA will release its new edition of the DSM. ... Symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.
    [Show full text]
  • Realising Stratified Psychiatry Using Multidimensional Signatures and Trajectories Dan W
    Joyce et al. J Transl Med (2017) 15:15 DOI 10.1186/s12967-016-1116-1 Journal of Translational Medicine METHODOLOGY Open Access Realising stratified psychiatry using multidimensional signatures and trajectories Dan W. Joyce1*, Angie A. Kehagia2, Derek K. Tracy1, Jessica Proctor1 and Sukhwinder S. Shergill1 Abstract Background: Stratified or personalised medicine targets treatments for groups of individuals with a disorder based on individual heterogeneity and shared factors that influence the likelihood of response. Psychiatry has traditionally defined diagnoses by constellations of co-occurring signs and symptoms that are assigned a categorical label (e.g. schizophrenia). Trial methodology in psychiatry has evaluated interventions targeted at these categorical entities, with diagnoses being equated to disorders. Recent insights into both the nosology and neurobiology of psychiatric disorder reveal that traditional categorical diagnoses cannot be equated with disorders. We argue that current quan- titative methodology (1) inherits these categorical assumptions, (2) allows only for the discovery of average treatment response, (3) relies on composite outcome measures and (4) sacrifices valuable predictive information for stratified and personalised treatment in psychiatry. Methods and findings: To achieve a truly ‘stratified psychiatry’ we propose and then operationalise two necessary steps: first, a formal multi-dimensional representation of disorder definition and clinical state, and second, the similar redefinition of outcomes as multidimensional
    [Show full text]
  • Definition and Description of Schizophrenia in the DSM-5
    SCHRES-05443; No of Pages 8 Schizophrenia Research xxx (2013) xxx–xxx Contents lists available at SciVerse ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres Review Definition and description of schizophrenia in the DSM-5 Rajiv Tandon a,⁎, Wolfgang Gaebel b, Deanna M. Barch c,d,e, Juan Bustillo f, Raquel E. Gur g,h,i, Stephan Heckers j, Dolores Malaspina k,l, Michael J. Owen m, Susan Schultz n, Ming Tsuang o,p,q, Jim Van Os r,s, William Carpenter t,u a Department of Psychiatry, University of Florida Medical School, Gainesville, FL, USA b Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Dusseldorf, Germany c Department of Psychology, Washington University, St. Louis, MO, USA d Department of Psychiatry, Washington University, St. Louis, MO, USA e Department of Radiology, Washington University, St. Louis, MO, USA f Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA g Department of Psychiatry, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA h Department of Neurology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA i Department of Radiology, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA j Department of Psychiatry, Vanderbilt University, Nashville, TN, USA k Department of Psychiatry, New York University, New York, NY, USA l Creedmoor Psychiatric Center, New York State Office of Mental Health, USA m MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience
    [Show full text]
  • Operationalizing NIMH Research Domain Criteria (Rdoc) in Naturalistic Clinical Settings
    Research Domain Criteria Sharp et al. Operationalizing NIMH Research Domain Criteria (RDoC) in naturalistic clinical settings Carla Sharp, PhD J. Christopher Fowler, PhD Ramiro Salas, PhD David Nielsen, PhD Jon Allen, PhD John Oldham, MD Thomas Kosten, MD Sanjay Mathew, MD Alok Madan, PhD, MPH B. Christopher Frueh, PhD Peter Fonagy, PhD Recently, the National Institute of Mental Health (NIMH) introduced the Research Domain Criteria (RDoC) initiative to address two major challenges facing the field of psychiatry: (1) the lack of new effective personalized treatments for psychiatric disorders, and (2) the limitations associated with categorically defined psychiatric disorders. Although the potential of RDoC to Carla Sharp is in the Department of Psychology, University of Houston, Houston, Texas. Carla Sharp, J. Christopher Fowler, Jon Allen, John Oldham, Sanjay Matthew, Alok Madan, B. Christopher Frueh, and Peter Fonagy are with The Menninger Clinic, Houston, Texas. J. Christopher Fowler, Ramiro Salas, David Nielsen, Jon Allen, John Oldham, Sanjay Mathew, and Alok Madan are with the Baylor College of Medicine, Houston, Texas. David Nielsen and Thomas Kosten are with the Michael DeBakey Veterans Affairs Medical Center, Houston, Texas. B. Christopher Frueh is at the University of Hawaii, Hilo, Hawaii. Peter Fonagy is at University College of London, London, UK. This work was partially supported by funding from The Menninger Clinic, The Mc- Nair Medical Institute, grants from the National Institutes of Health, and the Toomim Family Fund. We also acknowledge the contributions of Ian Aitken, Dr. Charles Neblett, and Dr. Stuart Yudofsky. This material is the result of work supported with resources and the use of facilities at the Michael E.
    [Show full text]
  • Protocol Summary Form 7107 Markx, Sander
    Protocol Summary Form 7107 Markx, Sander Protocol Title: Version Date: Pet Imaging Study of Old-Order Amish 11/04/2016 Patients with CNTNAP2 Mutations Protocol Number: 7107 First Approval: 09/22/2015 Expiration Date: 05/10/2017 Contact Principal Investigator: Co-Investigator(s): Sander Markx, MD Jeffrey Lieberman, MD Email: [email protected] Ragy Girgis, MD Telephone: 646-774-8627 Joshua Kantrowitz, MD Daniel Javitt, MD, PHD Research Chief: Daniel Javitt, MD, PHD Cover Sheet Choose from the following that is applicable to your study I am proposing an amendment only to an existing protocol Division & Personnel Division What Division/Department does the PI belong to? Expermintal Therapeutics/Psychiatry Within the division/department, what Center or group are you affiliated with, if any? N/A Unaffiliated Personnel List investigators, if any, who will be participating in this protocol but are not affiliated with New York State Psychiatric Institute or Columbia University. Provide: Full Name, Degrees and Affiliation. Dr. Kevin Strauss at the Clinic for Special Children at 535 Bunker Hill Road in Strasburg, PA (in close Page 1 of 32 Protocol Summary Form 7107 Markx, Sander proximity to Lancaster, PA) Amendment Describe the change(s) being made I am uploading our new, revised HIPAA form (we forgot to revise this for our recent amendment that was submitted and subsequently approved earlier this week). As previously discussed, we were amending our PSF and CF to now clearly state that the study is currently not funding by the NIMH but rather by a philanthropic donation that was made to us to complete this study.
    [Show full text]
  • The Evolution of DSM-5 Schizophrenia Spectrum Disorders
    Curr Psychiatry Rep (2013) 15:409 DOI 10.1007/s11920-013-0409-9 SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS (SJ SIEGEL, SECTION EDITOR) Defining Psychosis: The Evolution of DSM-5 Schizophrenia Spectrum Disorders Mahendra T. Bhati Published online: 22 September 2013 # Springer Science+Business Media New York 2013 Abstract Descriptions of mental illness exist throughout Introduction recorded history. However, until the mid-twentieth cen- tury, there was no standard nosology or diagnostic stan- Descriptions of mental illness exist throughout recorded his- dard for mental disorders. This limited understanding of tory and across cultures and civilizations. Written records of these disorders and development of better treatments. As mental illnesses such as depression and dementia are found in conditions such as dementia praecox and schizophrenia ancient texts including the ancient Egyptian Eber Papyrus (c. were being described, collaborative efforts were made in 1550 BC) [1] and Hindu scriptures such as the Mahabharata the twentieth century to develop the first Diagnostic and (c. 400 BC) [2]. Psychiatric disorders, including schizophre- Statistical Manual of Mental Disorders (DSM). This nia, are widely recognized throughout recorded history and review provides an overview of the history of psychiat- long recognized as a significant public health concern. How- ric diagnosis with a focus on the history of schizophre- ever, through most of history the lack of both systematic, nia as a diagnosis in the DSM. DSM-5 updates to evidence-based diagnoses and nosology for mental disorders diagnostic criteria for schizophrenia and related disor- posed significant limitations for understanding and develop- ders are provided. Limitations to diagnostic validity and ing better treatments for mental illnesses.
    [Show full text]
  • Chapter Three
    chapterthree three New Directions in Diagnosis Research Domain Criteria and Global Mental Health Bruce N. Cuthbert, PhD, and Thomas R. Insel, MD CHAPTER OUTLINE Introduction The Need for Research Domain Criteria Defining the Research Domain Criteria Conclusion: Dimensions of Psychopathology in Global Mental Health INTRODUCTION “One of the chief causes of poverty in science is imaginary wealth. The pur- pose of science is not to open the door to an infinitude of wisdom but to set some limit to the infinitude of error.”1 Research on the brain and behavior has entered an era of substantial enhancements in visibility with respect to both normal functioning and various types of brain disorders. Recent years have witnessed the Decade of the Brain (1990–2000) and the Decade of Behavior (2000–2010). For mental disorders, the period from approximately 2005 to 2015 might be called the “Decade of Diagnosis.” The American Psychiatric Association has been working on • 55 • 56 • CHAPTER 3 NEW DIRECTIONS IN DIAGNOSIS RESEARCH DOMAIN CRITERIA revisions for the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-V), slated for release in 2013. In parallel, the World Health Organization has been preparing for the release of the ICD-11 in 2015, which includes revisions to the sections on mental and behavioral disorders. Finally, in the spring of 2009, the National Institute of Mental Health (NIMH) announced a new initiative, the Research Domain Criteria project (RDoC), intended to provide a research classification system organized around key dimensions of functionality as informed by emerging data from genomics, clinical neurosci- ence, and behavioral science.
    [Show full text]
  • THOMAS A. BAN: Rdoc in HISTORICAL PERSPECTIVE Redefining Mental Illness by Tanya M
    1 Collated February 9, 2017 THOMAS A. BAN: RDoC IN HISTORICAL PERSPECTIVE Redefining Mental Illness by Tanya M. Luhrmann with Samuel Gershon’s question Collated Document Olaf Fjetland This collated document includes Thomas A. Ban’s essay, “RDoC in Historical Perspective,” posted on February 19, 2015, and includes a critical question by Samuel Gershon regarding the RDoC and the other exchanges that followed the posting of this essay. Six participants exchanged a total of nine postings, including three postings by Samuel Gershom (of which one was incorporated in Ban’s essay), two postings by Thomas A. Ban, and one posting each by Bernard Carroll, Jose de Leon, Martin M. Katz and Antonio Nardi. The last entry in this exchange was made on Octoberr 1, 2015. This collated document is now open to all INHN members for final comment. Thomas Ban February 19, 2015 essay Samuel Gershon February 19, 2015 question on RDoC incorporated in Ban’s essay Bernard Carroll March 5, 2015 reply Samuel Gershon’s question Thomas A. Ban October 1, 2015 comment on Carroll’s answer to Gershon’s question Samuel Gershon March 12, 2015 response to Carroll’s reply Martin Katz March 19, 2015 comment on RDoC Antonio E. Nardi March 26, 2015 comment on RDoC Samuel Gershon May 21, 2015 reply to Martin Katz and Antonio Nardi’s comment Jose de Leon April 30, 2015 comment on RDoC RDoC IN HISTORICAL PERSPECTIVE Redefining Mental Illness by Tanya M. Luhrmann with Samuel Gershon’s question Thomas A. Ban In her article, “Redefining Mental Illness”, published in the Sunday Review of New York Times on January 17, 2015 (http://www.nytimes.com/2015/01/18/opinion/sunday/t-m-luhrmann- redefining-mental-illness.html?_r=0), Tanya Luhrmann wrote that in 2013, Thomas R.
    [Show full text]