New diagnosis in psychiatry: beyond heuristics

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 bett...

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Published inPsychological medicine Vol. 55; p. e26
Main Authors McGorry, Patrick D., Hickie, Ian B., Kotov, Roman, Schmaal, Lianne, Wood, Stephen J., Allan, Sophie M., Altınbaş, Kürşat, Boyce, Niall, Bringmann, Laura F., Caspi, Avshalom, Cuthbert, Bruce, Gawęda, Łukasz, Groen, Robin N., Guloksuz, Sinan, Hartmann, Jessica A., Krueger, Robert F., Mei, Cristina, Nieman, Dorien, Öngür, Dost, Raballo, Andrea, Scheffer, Marten, Schreuder, Marieke J., Shah, Jai L., Wigman, Johanna T. W., Yuen, Hok Pan, Nelson, Barnaby
Format Journal Article
LanguageEnglish
Published Cambridge, UK Cambridge University Press 06.02.2025
Subjects
Biomarkers
Boundaries
Candidates
Classification
Clinical research
Cognitive ability
Confusion
Diagnosis
Diagnostic and Statistical Manual of Mental Disorders
Frame analysis
Heuristic
Heuristics
Humans
Infrastructure
Medical diagnosis
Mental disorders
Mental Disorders - classification
Mental Disorders - diagnosis
Mental health
Original
Original Article
Paradigms
Policy making
Precision medicine
Problem solving
Psychiatry
Psychiatry - methods
Psychopathology
Stagnation
Statistical models
Research Domain Criteria (RDoC)
the Hierarchical Taxonomy of Psychopathology (HiTOP)
Complex Systems
Psychiatric Diagnosis
Clinical Staging
Clinical Utility
Paradigm Shift
Network Analysis
Online AccessGet full text
ISSN0033-2917
1469-8978
1469-8978
DOI10.1017/S003329172400223X

Cover

Abstract 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. 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. 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. 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.
AbstractList 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.BACKGROUNDDiagnosis 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.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.METHODSWe 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.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.RESULTSThese 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.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.CONCLUSIONSSeveral 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.
BackgroundDiagnosis 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.MethodsWe 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.ResultsThese 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.ConclusionsSeveral 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.
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. 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. 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. 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.
ArticleNumber e26
Author Yuen, Hok Pan
Boyce, Niall
Nelson, Barnaby
Groen, Robin N.
Wood, Stephen J.
Shah, Jai L.
Guloksuz, Sinan
Scheffer, Marten
McGorry, Patrick D.
Krueger, Robert F.
Raballo, Andrea
Wigman, Johanna T. W.
Caspi, Avshalom
Mei, Cristina
Bringmann, Laura F.
Kotov, Roman
Cuthbert, Bruce
Öngür, Dost
Schmaal, Lianne
Hartmann, Jessica A.
Hickie, Ian B.
Allan, Sophie M.
Altınbaş, Kürşat
Nieman, Dorien
Schreuder, Marieke J.
Gawęda, Łukasz
AuthorAffiliation 20 Department of Public Mental Health, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University , Heidelberg , Germany
27 Department of Psychiatry, McGill University , Montreal , QC , Canada
7 Department of Psychiatry, Selcuk University Faculty of Medicine , Konya , Turkey
4 Department of Psychiatry, Stony Brook University , Stony Brook , New York , USA
9 Department of Psychometrics and Statistics, University of Groningen , Groningen , The Netherlands
17 Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences , Warsaw , Poland
1 Orygen , Parkville , VIC , Australia
26 Wageningen University , Wageningen , The Netherlands
8 Wellcome , London , UK
11 Department of Psychology and Neuroscience, Duke University , Durham , NC , USA
29 ACCESS Open Minds, Douglas Mental Health University Institute , Montreal , QC , Canada
28 Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute , Montreal , QC , C
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Keywords Research Domain Criteria (RDoC)
the Hierarchical Taxonomy of Psychopathology (HiTOP)
Complex Systems
Psychiatric Diagnosis
Clinical Staging
Clinical Utility
Paradigm Shift
Network Analysis
Language English
License http://creativecommons.org/licenses/by/4.0 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
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Snippet Diagnosis in psychiatry faces familiar challenges. Validity and utility remain elusive, and confusion regarding the fluid and arbitrary border between mental...
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SubjectTerms Biomarkers
Boundaries
Candidates
Classification
Clinical research
Cognitive ability
Confusion
Diagnosis
Diagnostic and Statistical Manual of Mental Disorders
Frame analysis
Heuristic
Heuristics
Humans
Infrastructure
Medical diagnosis
Mental disorders
Mental Disorders - classification
Mental Disorders - diagnosis
Mental health
Original
Original Article
Paradigms
Policy making
Precision medicine
Problem solving
Psychiatry
Psychiatry - methods
Psychopathology
Stagnation
Statistical models
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Title New diagnosis in psychiatry: beyond heuristics
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