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Clinical classification in mental health at the cross-roads


Senior Member

Much greater effort needs to be invested in the reverse translation agenda (that is, working back from the bedside to the bench). For example, we urgently need to unravel what neurobiological factors differentiate those with schizophrenia who respond to clozapine or those with bipolar disorder who respond to lithium. The goal is to develop better predictors of treatment-response before initiating therapies...

Another clear way of approaching this desire for greater specificity is to focus on syndromes that are closely linked with discrete environmental exposures, social adversity or inter-current medical events [152]. These natural experiments can be used to facilitate more targeted pathophysiological studies (for example, post-infective or post-stroke neuropsychiatric syndromes; post-traumatic depressive states; depression or prolonged fatigue states following cancer therapies; alcohol or other substance misuse neuropsychiatric syndromes; cannabis-associated first episode of psychosis

In other clinical domains (for example, oncology, coronary heart disease, inflammatory join disease), it is totally inadequate to choose treatments, or plan health care, for persons who suffer from recurring or progressive conditions simply on the basis of a broad diagnostic category (for example, breast cancer). We suggest that it is equally meaningless in mental health to select specific treatments on the basis of broad categories such as schizophrenia, bipolar disorder or major depression. ...