Problems of psychopathologic systematics: alternative approaches and clinical practice requests

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Abstract

The reliability and validity of traditional classifications give rise to justifiable criticism because of the conventionality of the boundaries between norm and pathology, fuzzy delimitation of disorders and their frequent co-occurrence, heterogeneity and clinical instability of symptoms within the diagnostic categories. There is little evidence that the majority of mental disorders are discrete entities. Discontent with the expert consensus classifications have led to attempts at a new quantitative and empirical systematization of psychopathology. Two alternative projects have been proposed: Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP). The aim of the paper is to clarify the conceptual framework of RDoC and HiTOP, discuss their advantages and disadvantages in terms of the prospects for use in clinical practice.

About the authors

Мikhail L. Zobin

Centre of transformational therapy of addictions “Dobrota”

Author for correspondence.
Email: dr.zobin@yandex.ru
Montenegro, 85330, Kotor, Dobrota BB

Natalia V. Ustinova

Pediatric research Institute of Central Clinical Hospital of the Russian Academy of Sciences; Research and practical center for mental health of children and adolescents named after G.E. Sukhareva

Email: ust-doctor@mail.ru
Russian Federation, 199333, Moscow, ul. Fotievoy, 10, bld. 1; 119334, Moscow, 5 th Donskoy proezd, 21a

References

  1. Jablensky A. Psychiatric classifications: validity and utility. World Psychiatry. 2016; 15 (1): 26–31.
  2. Masyn K.E., Henderson C.E., Greenbaum P.E. Exploring the latent structures of psychological constructs in social development using the dimensional-categorical spectrum. Soc. Dev. 2018; 12: 82–86.
  3. Cuthbert B.N. Dimensional models of psychopathology: Research agenda and clinical utility. J. Abnorm. Psychol. 2005; 114 (4): 565–569.
  4. Widiger T.A., Samuel D.B. Diagnostic categories or dimensions? A question for the Diagnostic and Statistical Manual of Mental Disorders-fifth edition. J. Abnorm. Psychol. 2005; 114 (4): 494–504.
  5. Kotov R., Krueger R.F., Watson D. A paradigm shift in psychiatric classification: the Hierarchical Taxonomy Of Psychopathology (HiTOP). World Psychiatry. 2018; 17 (1): 24–25.
  6. Markon K.E., Chmielewski M., Miller C.J. The reliability and validity of discrete and continuous measures of psychopathology: a quantitative review. Psychiatr. Bull. 2011; 137: 856–879.
  7. Waszczuk M.A., Zimmerman M., Ruggero C. et al. What do clinicians treat: diagnoses or symptoms? The incremental validity of a symptom-based, dimensional characterization of emotional disorders in predicting medication prescription patterns. Compr. Psychiatry. 2017; 79: 80–88.
  8. Taylor D. Prescribing according to diagnosis: how psychiatry is different. World Psychiatry. 2016; 15 (3): 224–225.
  9. Maj M. Why the clinical utility of diagnostic categories in psychiatry is intrinsically limited and how we can use new approaches to complement them. World Psychiatry. 2018; 17 (2): 121–122.
  10. First M.B., Rebello T.J., Keeley J.W. et al. Do mental health professionals use diagnostic classifications the way we think they do? A global survey. World Psychiatry. 2018; 17 (2): 187–195.
  11. Kirmayer L.J., Grafa D. What kind of science for psychiatry? Front. Hum. Neurosci. 2014. https://doi.org/10.3389/fnhum.2014.00435 (access date: 20.04.2020).
  12. Shorter E. Psychiatry and fads: why is this field different from all other fields? Can. J. Psychiatry. 2013; 58 (10): 555–559.
  13. Katz M.M., Cole J.O., Barton W.E. The role and methodology of classification in psychiatry and psychopathology. Public Health Service Publication No. 1584. Washington, D.C.: U.S. Govt. 1965; 72–76.
  14. Blashfield R. The classification of psychopathology: neo-kraepelinian and quantitative approaches. New York: Plenum Press. 1984; 328 p.
  15. Krueger R.F., Kotov R., Watson D. et al. Progress in achieving quantitative classification of psychopathology. World Psychiatry. 2018; 17 (3): 282–293.
  16. Kapur S., Phillips A.G., Insel T.R. Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Mol. Psychiatry. 2012; 17: 1174–1179.
  17. Insel T., Cuthbert B., Garvey M. et al. Research Domain Criteria (RDoC): toward a new classification framework for research on mental disorders. Am. J. Psychiatry. 2010; 167: 748–751.
  18. Cuthbert B.N. The RDoC framework: facilitating transition from ICD/DSM to dimensional approaches that integrate neuroscience and psychopathology. World Psychiatry. 2014; 13, 28–35.
  19. Kotov R., Krueger R.F., Watson D. et al. The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. J. Abnorm. Psychol. 2017; 126: 454–477.
  20. Van Os J., Delespaul P., Wigman J. et al. Beyond DSM and ICD: introducing “precision diagnosis” for psychiatry using momentary assessment technology. World Psychiatry. 2013; 12 (2): 107–110.
  21. Markon K.E. How things fall apart: understanding the nature of internalizing through its relationship with impairment. J. Abnorm. Psychol. 2010; 119: 447–458.
  22. Jonas K., Markon K. A model of psychosis and its relationship with impairment. Soc. Psychiatry Psychiatr. Epidemiol. 2013; 48: 1367–1375.
  23. Krueger R.F., Markon K.E. A dimensional-spectrum model of psychopathology: progress and opportunities. Arch. Gen. Psychiatry. 2011; 68 (1): 10–11.
  24. Wakschlag L.S., Estabrook R., Petitclerc A. et al. Clinical implications of a dimensional approach: the normal: abnormal spectrum of early irritability. J. Am. Acad. Child Adolesc. Psychiatry. 2015; 54: 626–634.
  25. Garvey M., Avenevoli S., Anderson K. The National Institute of Mental Health Research Domain Criteria and Clinical Research in Child and Adolescent Psychiatry. J. Am. Acad. Child Adolesc. Psychiatry. 2016; 55 (2): 93–98.
  26. Yager J., Feinstein R.E. Potential applications of the National Institute of Mental Health’s Research Domain Criteria (RDoC) to clinical psychiatric practice: how RDoC might be used in assessment, diagnostic processes, case formulation, treatment planning, and clinical notes. J. Clin. Psychiatry. 2017; 78 (4): 423–432.
  27. Harrison L.A., Kats A., Williams M.E., Aziz-Zadeh L. The importance of sensory processing in mental health: A proposed addition to the Research Domain Criteria (RDoC) and suggestions for RDoC 2.0. Front. Psychol. 2019; 10: 93.
  28. Keshavan M.S., Clementz B.A., Pearlson G.D. et al. Reimagining psychoses: an agnostic approach to diagnosis. Schizophr. Res. 2013; 146: 10–16.
  29. Livet J., Weissman T.A., Kang H. et al. Transgenic strategies for combinatorial expression of fluorescent proteins in the nervous system. Nature. 2007, 450 (7166): 56–62.
  30. Lichtman J., Livet J., Sanes J. A technicolour approach to the connectome. Nat. Rev. Neurosci. 2008; 9 (6): 417–422.
  31. Alivisatos A.P., Chun M., Church G.M. et al. The brain activity map project and the challenge of functional connectomics. Neuron. 2012; 74, 970–974.
  32. Pawelzik M.R. Commentary on Henrik Walter’s “The third wave of biological psychiatry”. Front. Psychol. 2013; 4: 832.
  33. Sanislow C.A. Updating the research domain criteria. World Psychiatry. 2016; 15 (3): 222–223.
  34. Tamminga C.A., Pearlson G., Keshavan M. et al. Bipolar and schizophrenia network for intermediate phenotypes: Outcomes Across the Psychosis Continuum. Schizophr. Bull. 2014; 40 (suppl. 2): S131–S137.
  35. Clementz B.A., Sweeney J.A., Hamm J.P. et al. Identification of distinct psychosis biotypes using brain-based biomarkers. Am. J. Psychiatry. 2015; 173: 373–384.
  36. Ivleva E.I., Clementz B.A., Dutcher A.M. et al. Brain structure biomarkers in the psychosis biotypes: Findings from the bipolar-schizophrenia network for intermediate phenotypes. Biol. Psychiatry. 2017; 82 (1): 26–39.
  37. Zhang W., Lei D., Keedy S.K. et al. Brain gray matter network organization in psychotic disorders. Neuropsychopharmacol. 2020; 45 (4): 666–674.
  38. Parnas J. The RDoC program: psychiatry without psyche? World Psychiatry. 2014; 13: 46–47.
  39. Helzer J.E., Kraemer H.C., Krueger R.F. et al. Dimensional approaches in diagnostic classification: refining the research agenda for DSM-V. Arlington: American Psychiatric Publishing. 2009; 115–127.
  40. Achenbach T.M., Rescorla L.A. Manual for the ASEBA school age forms and profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, and Families. 2001; 212 p.
  41. Achenbach T.M. The Achenbach System of Empirically Based Assessment (ASEBA): Development, findings, theory, and applications. Burlington: University of Vermont Research Center for Children, Youth, and Families. 2009; 122 p.
  42. John O.P., Robins R.W., Pervin L.A. Handbook of personality. New York: Guilford. 2008; 881 p.
  43. Van Os J., van der Steen Y., Islam M.A. et al. Investigators Evidence that polygenic risk for psychotic disorder is expressed in the domain of neurodevelopment, emotion regulation and attribution of salience. Psychol. Med. 2017; 47 (14): 2421–2437.
  44. Guloksuz S., van Os J. The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum. Psychol. Med. 2018; 48: 229–244.
  45. Docherty A.R., Fonseca-Pedrero E., Debbané M. et al. Enhancing psychosis-spectrum nosology through an international data sharing initiative. Schizophr. Bull. 2018; 44 (suppl. 2): S460–S467.
  46. Haslam N., Holland E., Kuppens P. Categories versus dimensions in personality and psychopathology: a quantitative review of taxometric research. Psychol. Med. 2012; 42: 903–920.
  47. Livesley W.J. Conceptual and taxonomic issues. In: Handbook of personality disorders: Theory, research, and treatment. W.J. Livesley ed. New York. Guilford Press. 2001; 3–38.
  48. Modestin J., Erni T. Testing the dissociative taxon. Psychiatry Res. 2004; 126 (1): 77–82.
  49. Elahi A., Perez Algorta G., Varese F. et al. Do paranoid delusions exist on a continuum with subclinical paranoia? A multi-method taxometric study. Schizophr. Res. 2017; 190: 77–81.
  50. Okbay A., Baselmans B., De Neve J. et al. Genetic variants associated with subjective well-being, depressive symptoms, and neuroticism identified through genome-wide analyses. Nat. Genet. 2016; 48: 624–633.
  51. Möller H.J., Bandelow B., Volz H.P. et al. The relevance of ‘mixed anxiety and depression’ as a diagnostic category in clinical practice. Eur. Arch. Psychiatry Clin. Neurosci. 2016; 266: 725–736.
  52. Andrews G., Goldberg D.P., Krueger R.F. et al. Exploring the feasibility of a meta-structure for DSM-V and ICD-11: could it improve utility and validity? Psychol. Med. 2009; 39: 1993–2000.
  53. Barlow D.H., Farchione T.J., Bullis J.R. et al. The unified protocol for transdiagnostic treatment of emotional disorders compared with diagnosis-specific protocols for anxiety disorders: a randomized clinical trial. JAMA Psychiatry. 2017; 74 (9): 875–884.
  54. Henningsen P. Management of somatic symptom disorder. Dialogues Clin. Neurosci. 2018; 20 (1): 23–31.
  55. Kendler K.S. Levels of explanation in psychiatric and substance use disorders: implications for the development of an etiologically based nosology. Mol. Psychiatry. 2012; 17: 11–21.
  56. Perkins E.R., Latzman R.D., Patrick C.J. Interfacing neural constructs with the Hierarchical Taxonomy of Psychopathology: “Why” and “how”. Personal Ment. Health. 2020; 14 (1): 106–122.
  57. Akram F., Giordano J. Research Domain Criteria as psychiatric nosology. Camb. Q. Healthc. Ethics. 2017; 26 (4): 592–601.
  58. Kleinman A. Rebalancing academic psychiatry: why it needs to happen — and soon. Br. J. Psychiatry. 2012; 201: 421–422.
  59. Fava G.A., Rafanelli C., Tomba E. The clinical process in psychiatry: a clinimetric approach. J. Clin. Psychiatry. 2012; 77: 173–178.
  60. Frances A. The past, present and future of psychiatric diagnosis. World Psychiatry. 2013; 12 (2): 111–112.
  61. Leucht S., Hierl S., Kissling W. et al. Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses. Br. J. Psychiatry. 2012; 200: 97–106.

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Copyright (c) 2020 Zobin М.L., Ustinova N.V.

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