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. 2013 May 14:11:125.
doi: 10.1186/1741-7015-11-125.

Clinical classification in mental health at the cross-roads: which direction next?

Ian B Hickie  1 , Jan Scott, Daniel F Hermens, Elizabeth M Scott, Sharon L Naismith, Adam J Guastella, Nick Glozier, Patrick D McGorry
Affiliations

Clinical classification in mental health at the cross-roads: which direction next?

Ian B Hickie et al. BMC Med. .

Abstract

Background: After 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.

Discussion: It is time to adopt new goals that prioritize the validation of clinical entities and foster alternative strategies to support those goals. The value of new dimensions (notably clinical staging), that are both clinically relevant and directly related to emerging developmental and neurobiological research, is proposed. A strong emphasis on 'reverse translation' (that is, working back from the clinic to the laboratory) underpins these novel approaches. However, it relies on using diagnostic groupings that already have strong evidence of links to specific risk factors or patterns of treatment response.

Summary: The strategies described abandon the historical divides between clinical neurology, psychiatry and psychology and adopt the promotion of pathways to illness models.

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Figures

Figure 1
Figure 1
A clinical staging model for post-pubertal onset and course of major mental disorders: developmental, circadian or anxiety pathophysiological pathways progress from non-specific to discrete syndromes. *Not necessarily a Diagnostic and Statistical Manual for Mental Disorders, fourth edition, or International Classification of Diseases - 10th revision diagnosis; GM: gray matter; WM: white matter.
See this image and copyright information in PMC

References

    1. Gustavsson A, Svensson M, Jacobi F, Allgulander C, Alonso J, Beghi E, Dodel R, Ekman M, Faravelli C, Fratiglioni L, Gannon B, Jones DH, Jennum P, Jordanova A, Jonsson L, Karampampa K, Knapp M, Kobelt G, Kurth T, Lieb R, Linde M, Ljungcrantz C, Maercker A, Melin B, Moscarelli M, Musayev A, Norwood F, Preisig M, Pugliatti M, Rehm J5. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21:718–779. doi: 10.1016/j.euroneuro.2011.08.008. - DOI - PubMed
    1. Collins PY, Patel V, Joestl SS, March D, Insel TR, Daar AS, Bordin IA, Costello EJ, Durkin M, Fairburn C, Glass RI, Hall W, Huang Y, Hyman SE, Jamison K, Kaaya S, Kapur S, Kleinman A, Ogunniyi A, Otero-Ojeda A, Poo M-M, Ravindranath V, Sahakian BJ, Saxena S, Singer PA, Stein DJ, Anderson W, Dhansay MA, Ewart W, Phillips A. Grand challenges in global mental health. Nature. 2011;475:27–30. doi: 10.1038/475027a. - DOI - PMC - PubMed
    1. Hickie IB, Groom GL, McGorry PD, Davenport TA, Luscombe GM. Australian mental health reform: time for real outcomes. Med J Aust. 2005;182:401–406. - PubMed
    1. Mental Health Council of Australia. Not For Service: Experiences of Injustice and Despair in Mental Health Care in Australia. Canberra: Mental Health Council of Australia; 2005.
    1. Insel TR, Sahakian BJ. Drug research: a plan for mental illness. Nature. 2012;483:269–269. doi: 10.1038/483269a. - DOI - PubMed

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