Transcending false dichotomies and diagnostic silos to reduce disease burden in mental disorders

McGorry, Patrick D.; Nelson, Barnaby; Wood, Stephen; Shah, Jai; Malla, Ashok; Yung, Alison

doi:10.1007/s00127-020-01913-w

Cited by 17 publications

(11 citation statements)

References 74 publications

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“…Rather, they and their families found that they had to "prove chronicity" to "deserve" and justify access to a model of care characterized by a blend of the "soft bigotry of low expectations", the "clinicians' illusion" 38 and a culture of neglect and low morale. Early intervention has been a very hard sell in psychiatry [39][40][41] .…”

Section: Current Status Of Mental Health Care For Young Peoplementioning

confidence: 99%

“…It is difficult to secure unity of purpose and mobilize a team effort within mental health to achieve beachheads and objectives of any kind. Doubt is introduced even when solid or highly promising scientific evidence has been assembled, for reasons and in ways that we do not see happening in other areas of health care 40 . Scepticism is a vital force in an empirical and pragmatic field like medicine, but it can be counter-productive and harmful if excessive or motivated by insecurity, vested interest or a self-defeating mindset.…”

Section: Paradigm Tensionsmentioning

confidence: 99%

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Designing and scaling up integrated youth mental health care

et al. 2022

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Mental ill‐health represents the main threat to the health, survival and future potential of young people around the world. There are indications that this is a rising tide of vulnerability and need for care, a trend that has been augmented by the COVID‐19 pandemic. It represents a global public health crisis, which not only demands a deep and sophisticated understanding of possible targets for prevention, but also urgent reform and investment in the provision of developmentally appropriate clinical care. Despite having the greatest level of need, and potential to benefit, adolescents and emerging adults have the worst access to timely and quality mental health care. How is this global crisis to be addressed? Since the start of the century, a range of co‐designed youth mental health strategies and innovations have emerged. These range from digital platforms, through to new models of primary care to new services for potentially severe mental illness, which must be locally adapted according to the availability of resources, workforce, cultural factors and health financing patterns. The fulcrum of this progress is the advent of broad‐spectrum, integrated primary youth mental health care services. They represent a blueprint and beach‐head for an overdue global system reform. While resources will vary across settings, the mental health needs of young people are largely universal, and underpin a set of fundamental principles and design features. These include establishing an accessible, “soft entry” youth primary care platform with digital support, where young people are valued and essential partners in the design, operation, management and evaluation of the service. Global progress achieved to date in implementing integrated youth mental health care has highlighted that these services are being accessed by young people with genuine and substantial mental health needs, that they are benefiting from them, and that both these young people and their families are highly satisfied with the services they receive. However, we are still at base camp and these primary care platforms need to be scaled up across the globe, complemented by prevention, digital platforms and, crucially, more specialized care for complex and persistent conditions, aligned to this transitional age range (from approximately 12 to 25 years). The rising tide of mental ill‐health in young people globally demands that this focus be elevated to a top priority in global health.

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Section: Current Status Of Mental Health Care For Young Peoplementioning

confidence: 99%

Section: Paradigm Tensionsmentioning

confidence: 99%

Designing and scaling up integrated youth mental health care

et al. 2022

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“…The existence of several major initiatives to reframe psychiatric diagnosis, including the Hierarchical Taxonomy of Psychopathology model [ 6 ], the network approach [ 7 ], and the clinical staging model [ 8 ], illustrates the ongoing need for new approaches to better understand psychopathology. It has become clear that syndromal diagnoses as defined in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM; [ 9 ]) and the World Health Organization’s International Classification of Disease (ICD; [ 10 ]) for the past four decades, while emphasizing reliability, have not borne out the identification of valid mechanisms.…”

Section: Introductionmentioning

confidence: 99%

Revisiting the seven pillars of RDoC

Morris

Sanislow

Pacheco

et al. 2022

BMC Med

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Background In 2013, a few years after the launch of the National Institute of Mental Health’s Research Domain Criteria (RDoC) initiative, Cuthbert and Insel published a paper titled “Toward the future of psychiatric diagnosis: the seven pillars of RDoC.” The RDoC project is a translational research effort to encourage new ways of studying psychopathology through a focus on disruptions in normal functions (such as reward learning or attention) that are defined jointly by observable behavior and neurobiological measures. The paper outlined the principles of the RDoC research framework, including emphases on research that acquires data from multiple measurement classes to foster integrative analyses, adopts dimensional approaches, and employs novel methods for ascertaining participants and identifying valid subgroups. Discussion To mark the first decade of the RDoC initiative, we revisit the seven pillars and highlight new research findings and updates to the framework that are related to each. This reappraisal emphasizes the flexible nature of the RDoC framework and its application in diverse areas of research, new findings related to the importance of developmental trajectories within and across neurobehavioral domains, and the value of computational approaches for clarifying complex multivariate relations among behavioral and neurobiological systems. Conclusion The seven pillars of RDoC have provided a foundation that has helped to guide a surge of new studies that have examined neurobehavioral domains related to mental disorders, in the service of informing future psychiatric nosology. Building on this footing, future areas of emphasis for the RDoC project will include studying central-peripheral interactions, developing novel approaches to phenotyping for genomic studies, and identifying new targets for clinical trial research to facilitate progress in precision psychiatry.

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“…Typically, it does not capture complexities related to homotypic/heterotypic continuity and comorbidity (Shah, 2019 ). Moreover, the basis of diagnostic guidelines had been repeatedly questioned with criteria seemingly determined by committees largely relying on cross-sectional research drawn from adult cohorts (McGorry, 2019 ; McGorry et al, 2020 ). This is especially problematic when applied to younger age groups where early development of mental illness usually consists of non-specific symptoms that lack clear syndromal characteristics or boundaries (Hickie et al, 2019b ).…”

Section: Current Relevance Of a Transdiagnostic Staging Model For Chi...mentioning

confidence: 99%

Transdiagnostic Clinical Staging for Childhood Mental Health: An Adjunctive Tool for Classifying Internalizing and Externalizing Syndromes that Emerge in Children Aged 5–11 Years

Sawrikar

MacBeth

Gillespie‐Smith

et al. 2022

Clin Child Fam Psychol Rev

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Clinical staging is now recognized as a key tool for facilitating innovation in personalized and preventative mental health care. It places a strong emphasis on the salience of indicated prevention, early intervention, and secondary prevention of major mental disorders. By contrast to established models for major mood and psychotic syndromes that emerge after puberty, developments in clinical staging for childhood-onset disorders lags significantly behind. In this article, criteria for a transdiagnostic staging model for those internalizing and externalizing disorders that emerge in childhood is presented. This sits alongside three putative pathophysiological profiles (developmental, circadian, and anxious-arousal) that may underpin these common illness trajectories. Given available evidence, we argue that it is now timely to develop a transdiagnostic staging model for childhood-onset syndromes. It is further argued that a transdiagnostic staging model has the potential to capture more precisely the dimensional, fluctuating developmental patterns of illness progression of childhood psychopathology. Given potential improvements in modelling etiological processes, and delivering more personalized interventions, transdiagnostic clinical staging for childhood holds much promise for assisting to improve outcomes. We finish by presenting an agenda for research in developments of transdiagnostic clinical staging for childhood mental health.

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Transcending false dichotomies and diagnostic silos to reduce disease burden in mental disorders

Cited by 17 publications

References 74 publications

Designing and scaling up integrated youth mental health care

Designing and scaling up integrated youth mental health care

Revisiting the seven pillars of RDoC

Transdiagnostic Clinical Staging for Childhood Mental Health: An Adjunctive Tool for Classifying Internalizing and Externalizing Syndromes that Emerge in Children Aged 5–11 Years

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