2013
DOI: 10.1186/1741-7015-11-125
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Clinical classification in mental health at the cross-roads: which direction next?

Abstract: BackgroundAfter 30 years of consensus-derived diagnostic categories in mental health, it is time to head in new directions. Those categories placed great emphasis on enhanced reliability and the capacity to identify them via standardized checklists. Although this enhanced epidemiology and health services planning, it failed to link broad diagnostic groupings to underlying pathophysiology or specific treatment response.DiscussionIt is time to adopt new goals that prioritize the validation of clinical entities a… Show more

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Cited by 80 publications
(95 citation statements)
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References 180 publications
(138 reference statements)
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“…As such, this tripartite model builds on established diagnostic categories, extending them to sub-threshold presentations via the use of a clinical staging framework, and further refining them by classifying cases on the basis of a putative clinical phenotype linked to a proposed underlying pathophysiology and illness trajectory. However, it differs from other historical approaches to classifications that have traditionally given more weight to psychotic symptoms - because these were perceived as most relevant to diagnostic hierarchies [4,13,69]. Our approach is supported by contemporary evidence that increasingly emphasizes the importance of developmental psychopathology and highlights the key role of anxiety and depression in the evolution of most adult prototype severe mental disorders and offers a rationale for giving greater priority to these symptoms [22,33,70].…”
Section: Discussionmentioning
confidence: 99%
“…As such, this tripartite model builds on established diagnostic categories, extending them to sub-threshold presentations via the use of a clinical staging framework, and further refining them by classifying cases on the basis of a putative clinical phenotype linked to a proposed underlying pathophysiology and illness trajectory. However, it differs from other historical approaches to classifications that have traditionally given more weight to psychotic symptoms - because these were perceived as most relevant to diagnostic hierarchies [4,13,69]. Our approach is supported by contemporary evidence that increasingly emphasizes the importance of developmental psychopathology and highlights the key role of anxiety and depression in the evolution of most adult prototype severe mental disorders and offers a rationale for giving greater priority to these symptoms [22,33,70].…”
Section: Discussionmentioning
confidence: 99%
“…A more nuanced understanding of the symptom profile of the patient allows clinicians to identify the maladaptive personality traits that may be underlying the disorder. This allows for targeted and personalized treatment based on the strengths and weaknesses of each patient, which may otherwise be overlooked applying a categorical model (Coyne, 2013;Hickie et al, 2013).…”
Section: Implications For Diagnosismentioning
confidence: 99%
“…12 There is also accumulating evidence that mental disorders can progress to more severe states over time, whether as a worsening of the current syndrome or as a progression to a different and more severe illness class. 13 The earliest observable expressions of severe psychopathology are often a mix of nonspecific anxiety and depressive symptoms, which gradually develop into more distinct syndromes.…”
mentioning
confidence: 99%
“…13 The earliest observable expressions of severe psychopathology are often a mix of nonspecific anxiety and depressive symptoms, which gradually develop into more distinct syndromes. 12 Stage-based stepped care…”
mentioning
confidence: 99%
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