From Many to One to Many—the Search for Causes of Psychiatric Illness

Kendler, Kenneth S.

doi:10.1001/jamapsychiatry.2019.1200

Cited by 101 publications

(90 citation statements)

References 50 publications

(58 reference statements)

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“…At still higher stages, the emphasis should first be on examining which novel, combined or alternative treatment strategies are required to improve immediate outcomes or prevent progression or extension of illness – and “reverse translating” this to identify the critical transitions, junctures or step‐wise discontinuities in illness course (which might distinguish between putative stages) that such interventions address. The extent to which clinical transitions correspond to objective or neurobiological “markers” is also the subject of active clinical research 6,37 ; maintaining a central focus on clinical utility may allow staging to address recent critiques regarding psychiatry's thus far futile search for disorder‐specific biomarkers 39‐41 .…”

Section: Staging and Clinical Utilitymentioning

confidence: 99%

“…Finally, we recognize that there are other models either under development or articulated that also appreciate the transdiagnostic nature of mental illness, especially for research purposes 41‐44 . We do not see these as competing approaches: clinical staging is designed principally to enhance the delivery of highly personalized care, with its appeal being that it is explicitly meant for clinical practice.…”

Section: Staging and Clinical Utilitymentioning

confidence: 99%

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Transdiagnostic clinical staging in youth mental health: a first international consensus statement

Scott²,

et al. 2020

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Recognizing that current frameworks for classification and treatment in psychiatry are inadequate, particularly for use in young people and early intervention services, transdiagnostic clinical staging models have gained prominence. These models aim to identify where individuals lie along a continuum of illness, to improve treatment selection and to better understand patterns of illness continuity, discontinuity and aetiopathogenesis. All of these factors are particularly relevant to help‐seeking and mental health needs experienced during the peak age range of onset, namely the adolescent and young adult developmental periods (i.e., ages 12‐25 years). To date, progressive stages in transdiagnostic models have typically been defined by traditional symptom sets that distinguish “sub‐threshold” from “threshold‐level” disorders, even though both require clinical assessment and potential interventions. Here, we argue that staging models must go beyond illness progression to capture additional dimensions of illness extension as evidenced by emergence of mental or physical comorbidity/complexity or a marked change in a linked biological construct. To develop further consensus in this nascent field, we articulate principles and assumptions underpinning transdiagnostic clinical staging in youth mental health, how these models can be operationalized, and the implications of these arguments for research and development of new service systems. We then propose an agenda for the coming decade, including knowledge gaps, the need for multi‐stakeholder input, and a collaborative international process for advancing both science and implementation.

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Section: Staging and Clinical Utilitymentioning

confidence: 99%

Section: Staging and Clinical Utilitymentioning

confidence: 99%

Transdiagnostic clinical staging in youth mental health: a first international consensus statement

Scott²,

et al. 2020

View full text Add to dashboard Cite

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“…As Einstein commented, “things should be made as simple as possible – but not simpler”. In relation to mental health problems, Kendler has recently articulated this, noting the need to move beyond monocausal thinking.…”

Section: Social Defeatmentioning

confidence: 99%

Migration, ethnicity and psychoses: evidence, models and future directions

2019

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There is a large body of research reporting high rates of psychotic disorders among many migrant and minority ethnic groups, particularly in Northern Europe. In the context of increasing migration and consequent cultural diversity in many places worldwide, these findings are a major social and public health concern. In this paper, we take stock of the current state of the art, reviewing evidence on variations in rates of psychoses and putative explanations, including relevant theories and models. We discuss in particular: a) the wide variation in reported rates of psychotic disorders by ethnic group, and b) the evidence implicating social risks to explain this variation, at ecological and individual levels. We go on to set out our proposed socio-developmental model, that posits greater exposure to systemic social risks over the life course, particularly those involving threat, hostility and violence, to explain high rates of psychoses in some migrant and minority ethnic groups. Based on this analysis, the challenge of addressing this social and public health issue needs to be met at multiple levels, including social policy, community initiatives, and mental health service reform.

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“…Mental disorders are complex phenomena: highly heterogeneous and massively multifactorial (e.g., Kendler, 2019). Confronted with this complex etiological and ontological picture, researchers have increasingly called for approaches to psychiatric research that embrace this complexity (Gardner & Kleinman, 2019).…”

Section: Introductionmentioning

confidence: 99%

Modeling Psychopathology: From Data Models to Formal Theories

Haslbeck¹,

Ryan²,

Robinaugh³

et al. 2019

Preprint

112

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Over the past decade there has been a surge of empirical research investigating mental disorders as complex systems. In this paper, we investigate how to best make use of this growing body of empirical research and move the field toward its fundamental aims of explaining, predicting, and controlling psychopathology. We first review the contemporary philosophy of science literature on scientific theories and argue that fully achieving the aims of explanation, prediction, and control requires that we construct formal theories of mental disorders: theories expressed in the language of mathematics or a computational programming language. We then investigate three routes by which one can use empirical findings (i.e., data models) to construct formal theories: (a) using data models themselves as formal theories, (b) using data models to infer formal theories, and (c) comparing empirical data models to theory-implied data models in order to evaluate and refine an existing formal theory. We argue that the third approach is the most promising path forward. We conclude by introducing the Abductive Formal Theory Construction (AFTC) framework, informed by both our review of philosophy of science and our methodological investigation. We argue that this approach provides a clear and promising way forward for using empirical research to inform the generation, development, and testing of formal theories both in the domain of psychopathology and in the broader field of psychological science.

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From Many to One to Many—the Search for Causes of Psychiatric Illness

Abstract: Angeles, provided helpful comments on earlier versions of the manuscript. They were not financially compensated for their contributions. The manuscript was stimulated in part by reading the insightful essay of Ross. 10

Cited by 101 publications

References 50 publications

Transdiagnostic clinical staging in youth mental health: a first international consensus statement

Transdiagnostic clinical staging in youth mental health: a first international consensus statement

Migration, ethnicity and psychoses: evidence, models and future directions

Modeling Psychopathology: From Data Models to Formal Theories

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