Summaries of oral sessions at the XXI World Congress of Psychiatric Genetics, Boston, Massachusetts, 17-21 October 2013: state of the field (original) (raw)
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Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 2021
I t’s time for a necessary paradigm shift in re-conceptualizing the nosology, epidemiology, etiology, and treatment of major psychiatric disorders, including schizophrenia, bipolar disorder, major depressive disorder (MDD), autism spectrum disorder, attentiondeficit/hyperactivity disorder (ADHD), anxiety, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and substance use disorders. For a long time, and prior to the neuroscience revolution that enabled probing the human brain and exploring the neurobiology of psychiatric disorders, the field of psychiatry was descriptive and simplistic. It categorized psychiatric disorders essentially as silos, defined by a set of signs and symptoms. If one or more psychiatric conditions co-occurred with a “primary diagnosis,” they were labeled as “comorbidities,” with no implications of a shared etiology or biology. Amazingly, despite the rapid accrual of evidence of shared developmental or genetic etiopathogenesis, shared ...
Deeply Rooted Sources of Error and Bias in Psychiatric Classification
Defenders of the DSM claim that DSM-III (American Psychiatric Association 1980) was an important revolution in psychiatric classification and that the classification system is an invaluable tool in clinical practice and scientific research. Critics, on the other hand, argue that neither of these claims is defensible, that the DSM is profoundly flawed, and that DSM-III ushered in three decades of non-progressive research and misguided clinical practice. I agree with this critical position and will argue below that the DSM approach to classification is, indeed, profoundly flawed, as are the practices based upon it. But more broadly, a crisis exists in contemporary mental health practice:
Historically, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has met an important need in defining a common language of psychiatric diagnosis in North America. Understanding the development of the DSM can help researchers and practitioners better understand this diagnostic language. The history of the DSM, from its precursors to recent proposed revisions for its fifth edition, is reviewed and compared while avoiding the presentist bias. The development of DSM resembles a historic pendulum, from DSM-I emphasizing psychodynamics and causality to DSM-III and DSM-IV emphasizing empiricism and logical positivism. The proposed changes in etiological-and dimensional-based classification for DSM-V represent a slight backswing toward the center.
American Journal of Psychiatry, 2011
Objective-The authors sought to clarify the structure of the genetic and environmental risk factors for 22 DSM-IV disorders: 12 common axis I disorders and all 10 axis II disorders. Method-The authors examined syndromal and subsyndromal axis I diagnoses and five categories reflecting number of endorsed criteria for axis II disorders in 2,111 personally interviewed young adult members of the Norwegian Institute of Public Health Twin Panel. Results-Four correlated genetic factors were identified: axis I internalizing, axis II internalizing, axis I externalizing, and axis II externalizing. Factors 1 and 2 and factors 3 and 4 were moderately correlated, supporting the importance of the internalizing-externalizing distinction. Five disorders had substantial loadings on two factors: borderline personality disorder (factors 3 and 4), somatoform disorder (factors 1 and 2), paranoid and dependent personality disorders (factors 2 and 4), and eating disorders (factors 1 and 4). Three correlated environmental factors were identified: axis II disorders, axis I internalizing disorders, and externalizing disorders versus anxiety disorders. Conclusions-Common axis I and II psychiatric disorders have a coherent underlying genetic structure that reflects two major dimensions: internalizing versus externalizing, and axis I versus axis II. The underlying structure of environmental influences is quite different. The organization of common psychiatric disorders into coherent groups results largely from genetic, not environmental, factors. These results should be interpreted in the context of unavoidable limitations of current statistical methods applied to this number of diagnostic categories. Psychiatric disorders are clinical-historical constructs whose etiology and pathophysiology are largely unknown, and hence most psychiatric nosologies, including DSM-IV (1) and ICD-10 (2), arrange disorders into categories primarily on the basis of clinical similarities. Our field has long hoped for an etiologically based classification of psychiatric disorders. Of the possible organizing principles for such an approach, familial/genetic factors have frequently been emphasized (3-5).