Abstract
Knowledge concerning the classification of mental disorders progressed substantially with the use of DSM III-IV and IDCD 10 because it was based on observed data, with precise definitions. These classifications a priori avoided to generate definitions related to etiology or treatment response. They are based on a categorical approach where diagnostic entities share common phenomenological features. Modifications proposed or discussed are related to the weak validity of the classification strategy described above. (a) Disorders are supposed to be independent but the current coexistence of two or more disorders is the rule; (b) They also are supposed to have stability, however anxiety disorders most of the time precede major depression. For GAD age at onset, family history, biology and symptomatology are close to those of depression. As a consequence broader entities such as depression-GAD spectrum, panic-phobias spectrum and OCD spectrum including eating disorders and pathological gambling are taken into consideration; (c) Diagnostic categories use thresholds to delimitate a border with normals. This creates “subthreshold” conditions. The relevance of such conditions is well documented. Measuring the presence and severity of different dimensions, independent from a threshold, will improve the relevance of the description of patients pathology. In addition, this dimensional approach will improve the problems posed by the mutually exclusive diagnoses (depression and GAD, schizophrenia and depression); (d) Some disorders are based on the coexistence of different dimensions. Patients may present only one set of symptoms and have different characteristics, evolution and response to treatment. An example would be negative symptoms in Schizophrenia; (e) Because no etiological model is available and most measures are subjective, objective measures (cognitive, biological) and genetics progresses created important hopes. None of these measures is pathognomonic and most appear to be related to risk factors especially at certain periods when associated with environmental events. One of the major aims for a classification of patients is to identify groups to whom a best possible therapeutic strategy can be proposed. Drugs may improve fear extinction while the genetic and/or acquired avoidance may be called phobia. The basic mechanism and or the corresponding phenotype should appear in the classification. Progresses in early identification of disturbances by taking into account all the information available (prodromal symptoms, cognitive, biological, imaging, genetic, family information) are crucial for the future therapeutic strategy: prevention.
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References
APA (1994) Diagnostic and statistical manual of mental disorders DSM-IV. American Psychiatric Association, Washington
APA (2000) Diagnostic criteria from DSM-IV-TR. American Psychiatric Association, Washington
Balázs J, Bitter I, Lecrubier Y, Csiszér N, Ostorharics G (2000) Prevalence of subthreshold forms of psychiatric disorders in persons making suicide attempts in Hungary. Eur Psychiatry 15(6):354–361
Cannon M, Jones PB, Murray RM (2002) Obstetric complications and schizophrenia: historical and meta-analytic review. Am J Psychiatry 159:1080–1092
Cardno AG, Rijsdijk FV, Sham PC, Murray RM, McGuffin P (2002) A twin study of genetic relationships between psychotic symptoms. Am J Psychiatry 159(4):539–545
Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, McClay J, Mill J, Martin J, Braithwaite A, Poulton R (2003) Influence of life stress on depression: moderation by a polymorphism in the 5–HTT gene. Science 301(5631):386–389
Caspi A, Moffitt TE, Cannon M, McClay J, Murray R, Harrington H, Taylor A, Arseneault L, Williams B, Braithwaite A, Poulton R, Craig IW (2005) Moderation of the effect of adolescent-onset cannabis use on adult psychosis by a functional polymorphism in the catechol-O-methyltransferase gene: longitudinal evidence of a gene X environment interaction. Biol Psychiatry 57(10):1117–1127
First MB (2005) Mutually Exclusive versus co-occuring diagnostic categories: the challenge of diagnostic comorbidity. Psychopathology 38(4):206–210
Goldapple K, Segal Z, Garson C, Lau M, Bieling P, Kennedy S, Mayberg H (2004) Modulation of cortical-limbic pathways in major depression. Treatment-specific effects of cognitive behavior therapy. Arch Gen Psychiatry 61(1):34–41
Gould TD, Gottesman II (2006) Psychiatric endophenotypes and the development of valid animal models. Genes Brain Behav 5(2):113–9
Harvey PD, Keefe RS (2001) Studies of cognitive change in patients with schizophrenia following novel antipsychotic treatment. Am J Psychiatry 158(2):176–184
Hofmann SG, Meuret AE, Smits JA, Simon NM, Pollack MH, Eisenmenger K, Shiekh M, Otto MW (2006) Augmentation of exposure therapy with d-cycloserine for social anxiety disorder. Arch Gen Psychiatry 63(3):298–304
Judd LL, Akiskal HS, Maser JD, Zeller PJ, Endicott J, Coryell W, Paulus MP, Kunovac JL, Leon AC, Mueller TI, Rice JA, Keller MB (1998) Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord 50(2–3):97–108
Kapur S, Mizrahi R, Li M (2005) From dopamine to salience to psychosis-linking biology, pharmacology and phenomenology of psychosis. Schizophr Res 79(1):59–68
Kellendonk C, Simpson EH, Polan HJ, Malleret G, Vronskaya S, Winiger V, Moore H, Kandel ER (2006) Transient and selective overexpression of dopamine D2 receptors in the striatum causes persistent abnormalities in prefrontal cortex functioning. Neuron 49(4):603–615
Kendler KS (2006) Reflections on the relationship between psychiatric genetics and psychiatric nosology. Am J Psychiatry 163(7):1138–1146
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the national comorbidity survey. Arch Gen Psychiatry 51:8–19
Kessler RC, Nelson CB, Mcgonagle KA, Liu J, Swartz M, Blazer DG (1996) Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US national comorbidity survey. Br J Psychiatry 168(30):17–30
Kirkpatrick B, Fenton WS, Carpenter WT, Marder SR (2006) The NIMH-MATRICS consensus statement on negative symptoms. Schizophr Bull 32(2):214–219
Larsen TK, Friis S, Haahr U, Joa I, Johannessen JO, Melle I, Opjordsmoen S, Simonsen E, Vaglum P (2001) Early detection and intervention in first-episode schizophrenia: a critical review. Acta Psychiatr Scand 103(5):323–334
Laruelle M, Abi-Dargham A, van Dyck CH, Gil R, D’Souza CD, Erdos J, McCance E, Rosenblatt W, Fingado C, Zoghbi SS, Baldwin RM, Seibyl JP, Krystal JH, Charney DS, Innis RB (1996) Single photon emission computerized tomography imaging of amphetamine-induced dopamine release in drug-free schizophrenic subjects. Proc Natl Acad Sci USA 93(17):9235–9240
Lecrubier Y (2001) The influence of comorbidity on the prevalence of suicidal behavior. Eur Psychiatry 16:395–399
Lecrubier Y (1993) The importance of national therapeutic strategies for the treatment of subthreshold depressive disorders. Eur Psychiatry 8(5):233–234
Lecrubier Y, Sheehan DV, Weiller E, Armorin P, Bonara I, Sheehan KH, Janavs J, Dunbar GC (1997) The mini international neuropsychiatric interview (MINI) a short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry 12(5):224–231
MATRICS, available at http://www.matrics.ucla.edu
Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, Schwalb JM, Kennedy SH (2005) Deep brain stimulation for treatment-resistant depression. Neuron 45:651–660
Mc Gurk SR, Meltzer HY (2000) The role of cognition in vocational functioning in schizophrenia. Schizophr Res 45(3):175–184
Melle I, Larsen TK, Haahr U, Friis S, Johannessen JO, Opjordsmoen S, Simonsen E, Rund BR, Vaglum P, McGlashan T (2004) Reducing the duration of untreated first-episode psychosis: effects on clinical presentation. Arch Gen Psychiatry 61(2):143–150
Meltzer HY, McGurk SR (1999) The effects of clozapine, ripseridone and olanzapine on cognitive function in schizophrenia. Schizophr Bull 25(2):233–255
Montgomery SA, Van Zwieten-Boot B (2007) ECNP consensus meeting. Negative, depressive and cognitive symptoms of schizophrenia. Nice, March 2004. Eur Neuropsychopharmacol 17:70–77
Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J, Parker S, Bentall RP (2004) Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. Br J Psychiatry 185:291–297
Paykel ES, Ramana R, Cooper Z, Hayhurst H, Kerr J, Barocka A (1995) Residual symptoms after partial remission: an important outcome in depression. Psychol Med 25(6):1171–1180
Pedersen CB, Mortensen PB (2001) Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Arch Gen Psychiatry 58(11):1039–1046
Phillips KA, Kaye WH (2007) The relationship of body dysmorphic disorder and eating disorders to obsessive-compulsive disorder. CNS Spectr 12(5):347–358
Regier DA, Rae DS, Narrow WE, Kaelber CT, Schatzberg AF (1998) Prevalence of anxiety disorders and their comorbidity with mood and addictive disorders. Br J Psychiatry 173(34):24–28
Ressler KJ, Rothbaum BO, Tannenbaum L, Anderson P, Graap K, Zimand E, Hodges L, Davis M (2004) Cognitive enhancers as adjuncts to psychotherapy: use of d-cycloserine in phobic individuals to facilitate extinction of fear. Arch Gen Psychiatry 61(11):1136–1144
Rickels K, Downing R, Schweizer R, Hassman H (1993) Antidepressants for the treatment of imipramine, trazodone and diazepam. Arch Gen Psychiatry 50:884–895
Robins LN, Wing J, Wittchen H-U, Helzer JE (1988) The composite international diagnostic interview: an epidemiological instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45:1069–1077
Size and burden of mental disorders in Europe (2005) European Neuropsychopharmacology 15(4):355–490
Selten JP, Cantor-Graae E (2005) Social defeat: risk factor for schizophrenia? Br J Psychiatry 187:101–102
Seminowicz DA, Mayberg HS, McIntosh AR, Goldapple K, Kennedy S, Segal Z, Rafi-Tari S (2004) Limbic-frontal circuitry in major depression: a path modelling metanalysis. Neuroimage 22:409–418
Sheehan DV, Lecrubier Y, Sheehan KH, Janavs J, Weiller E, Keskiner A, Schinka J, Knapp E, Sheehan MF, Dunbar GC (1997) Reliability and validity of the mini international neuropsychiatric interview (MINI) according to SCID-P. Eur Psychiatry 12(5):232–241
Watson D (2005) Rethinking the mood and anxiety disorders; a quantitative hierarchical model for DSM-V. J Abnorm Psychol 114(4):522–536
Wittchen H-U, Beesdo K, Bittner A, Goodwin RD (2003) Depressive episodes-evidence for a causal role of primary anxiety disorders? Eur Psychiatry 18:384–393
Wolf DH (2006) Anhedonia in Schizophrenia. Curr Psychiatry Rep 8:322–328
Woods SW, Breier A, Zipursky RB, Perkins DO, Addington J, Miller TJ, Hawkins KA, Marquez E, Lindborg SR, Tohen M, McGlashan TH (2003) Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome. Biol Psychiatry 54(4):453–464
World Health Organisation (1993) The ICD-10 classification of mental and behavioral disorders: diagnostic criteria for research. World Health Organisation, Geneva, Swizerland
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Lecrubier, Y. Refinement of diagnosis and disease classification in psychiatry. Eur Arch Psychiatry Clin Neurosc 258 (Suppl 1), 6–11 (2008). https://doi.org/10.1007/s00406-007-1003-0
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DOI: https://doi.org/10.1007/s00406-007-1003-0