Transsemptomatic Diagnosis as a Replacement for Transdiagnostic Approach in Psychiatry

Abstract

Traditionally, the DSM and ICD diagnostic systems have been based on the principle that mental disorders are separate diseases with different etiologies and clinical manifestations. On the other hand, the transdiagnostic approach argues that many diseases such as anxiety and depression share a common etiology and have similar clinical features, pointing to the great overlap between different psychiatric disorders in genetic, epidemiological and neuroscience studies. In this context, the Research Domain Criteria (RDoC) project was initiated in order to create a research model and shape future classifications. Unlike traditional diagnostic classifications, RDoC assumes diseases as pathophysiology-based dysfunctions of the brain's neuronal circuits rather than symptom clusters. However, there are limitations in transdiagnostic approach studies such as complex methodologies, unclear criteria, inclusion of very different diagnoses in the same study, and insufficient inclusion of serious psychiatric diseases. In this article, the importance of correct diagnosis in psychiatry is stated by emphasizing “Trans-symptomatic diagnosis” instead of “Transdiagnostic approach”..

Keywords

• Transdiagnostic approach
• Research Domain Criteria
• transsymptomatic diagnosis

Psikiyatride Transdiagnostik (Tanı Ötesi) Yaklaşım Yerine Transsemptomatik (Semptom Ötesi) Tanı

Öz

Geleneksel olarak DSM ve ICD tanı sistemleri mental bozuklukları farklı etyolojileri ve klinik görünümleri sergileyen ayrı hastalıklar olduğu ilkesine dayanmaktadır. Buna karşın transdiagnostik yaklaşım genetik, epidemiyolojik ve sinirbilim araştırmalarında farklı psikiyatrik bozukluklar arasındaki büyük örtüşmelere işaret ederek anksiyete ve depresyon gibi birçok hastalığın ortak etyolojiyi paylaştığını ve benzer klinik özellikler taşıdığını savunur. Bu çerçevede bir araştırma modeli oluşturmak ve gelecekteki sınıflandırmaları şekillendirmek amacıyla Araştırma Alanı Kriterleri (Research Domain Criteria, RDoC) projesi başlatılmıştır. RDoC geleneksel tanı sınıflandırmalarından farklı olarak hastalıkları semptom kümeleri yerine patofizyoloji temelli, beynin nöronal devrelerinin işlev bozuklukları olarak değerlendirir. Ancak, transdiagnostik yaklaşım çalışmalarında karmaşık metodolojiler izlenmesi, kriterlerin net olmaması, çok farklı tanıların aynı çalışmaya dahil edilmesi ve ciddi psikiyatrik hastalıkların yeterince dahil edilmemesi şeklinde kısıtlılıklar bulunmaktadır. Bu yazıda “transdiagnositik (tanıl -ötesi) yaklaşım” yerine “transsemptomatik tanı (semptom ötesi tanı)” vurgulanarak psikiyatride doğru tanının önemi üzerinde durulmaktadır.

Anahtar Kelimeler

• Trandiagnostik yaklaşım
• Araştırma Alanı Kriterleri
• transsemptomatik tanı

References

1. Badcock JC, Hugdahl K (2014) A synthesis of evidence on inhibitory control and auditory hallucinations based on the Research Domain Criteria (RDoC) framework. Front Hum Neurosci, 8:180 .
2. Barch DM (2020) What does it mean to be transdiagnostic and how would we know? Am J Psychiatry, 177:370–372.
3. Buckholtz JW, Meyer-Lindenberg A (2012) Psychopathology and the human connectome: toward a transdiagnostic model of risk for mental ıllness. Neuron, 74:990–1004.
4. Caspi A, Houts RM, Belsky DW, Goldman-Mellor SJ, Harrington H, Israel S et al. (2014). The p Factor: One general psychopathology factor in the structure of psychiatric disorders? Clin Psychol Sci, 2:119-137.
5. Cuthbert BN, Insel TR (2013) Toward the future of psychiatric diagnosis: the seven pillars of RDoC. BMC Med, 11:126.
6. Cuthbert BN, Kozak MJ (2013) Constructing constructs for psychopathology: The NIMH research domain criteria. J Abnorm Psychol, 122:928–937.
7. Dalgleish T, Black M, Johnston D, Bevan A (2020) Transdiagnostic approaches to mental health problems: Current status and future directions. J Consult Clin Psychol, 88:179–195.
8. Elmer, GI, Brown PL, Shepard PD (2016) Engaging Research Domain Criteria (RDoC): Neurocircuitry in search of meaning. Schizophr Bull, 42:1090–1095.

9. Etkin A, Cuthbert B (2014) Beyond the DSM: Development of a transdiagnostic psychiatric neuroscience course. Acad Psychiatry, 38:145–150.
10. Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R (1972) Diagnostic criteria for use in psychiatric research. Arch Gen Psychiatry, 26:57–63.
11. Fusar-Poli P, Solmi M, Brondino N, Davies C, Chae C, Politi P et al. (2019) Transdiagnostic psychiatry: a systematic review. World Psychiatry, 18:192–207.
12. Gong Q, Scarpazza C, Dai J, He M, Xu X, Shi Y et al. (2019). A transdiagnostic neuroanatomical signature of psychiatric illness. Neuropsychopharmacology, 44:869-875.
13. Goodkind, M, Eickhoff SB, Oathes DJ, Jiang Y, Chang A, Jones-Hagata LB, et al. (2015) Identification of a common neurobiological substrate for mental illness. JAMA Psychiatry, 72:305-315.
14. Harvey AG, Murray G, Chandler RA, Soehner A (2011) Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms. Clin Psychol Rev, 31:225–235.
15. Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K et al. (2010) Research Domain Criteria (RDoC): Toward a new classification framework for research on mental disorders. Am J Psychiatry, 167:748–751.
16. Ma Q, Tang Y, Wang F, Liao X, Jiang X, Wei S et al. (2019) Transdiagnostic dysfunctions in brain modules across patients with schizophrenia, bipolar disorder, and major depressive disorder: A connectome-based study. Schizophr Bull, 46:699–712.
17. Marshall M (2020) Roots of mental illness. Nature, 581:19–21.
18. McTeague LM, Huemer J, Carreon DM, Jiang Y, Eickhoff SB, Etkin A. (2017) Identification of common neural circuit disruptions in cognitive control across psychiatric disorders. Am J Psychiatry, 174:676–685.
19. McTeague LM, Rosenberg BM, Lopez JW, Carreon DM, Huemer J, Jiang Y et al. (2020) Identification of common neural circuit disruptions in emotional processing across psychiatric disorders. Am J Psychiatry, 177:411-421
20. Nolen-Hoeksema S, Watkins ER (2011) A heuristic for developing transdiagnostic models of psychopathology. Perspect Psychol Sci, 6:589–609.
21. Ozcan H, Takim U (2021) 50 useful sociodemographic and clinical tips to overcome the challenge differentiating bipolar depression from unipolar depression. Eurasian J Med, 53:64-66.
22. Ozdemir O (2012a) Dimensional approach in psychiatry. Psikiyatride Güncel Yaklaşımlar, 4:315-334.
23. Ozdemir O (2012b). Psikiyatride tanıya yardımcı bir araç: Sezgi. Dusunen Adam, 25:283-284.