On the transdiagnostic nature of peripheral biomarkers in major psychiatric disorders: A systematic review

Pinto, Jairo Vinícius; Moulin, Thiago C.; Amaral, Olavo B.

doi:10.1016/j.neubiorev.2017.10.001

Cited by 78 publications

(55 citation statements)

References 77 publications

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“…Given the overlap of disorders and the realization that comorbidity is the norm, rather than the exception (160,161), there is now also increased traction behind the search for transdiagnostic markers of psychiatric dysfunction (11,162,163). This is typically done by looking across groups of patients with differential disorder diagnoses, rather than taking a disorder agnostic approach.…”

Section: The Potential Of Cross-disorder Assessmentmentioning

confidence: 99%

“…Secondly, across the landscape of mental health research there is a drive to better understand underlying etiologies to help deliver new treatment opportunities. One avenue is the development of physiological biomarkers to aid diagnosis of mental health disorders and guide discovery of pharmacological intervention (7)(8)(9)(10)(11)(12), although see (13,14). These studies often aim to reveal correlations between neurobiological changes in a patient's brain (e.g., using tools such as fMRI and EEG) and the presence or severity of a mental health diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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The Heterogeneity of Mental Health Assessment

Newson¹,

Hunter²,

Thiagarajan³

2020

Front. Psychiatry

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Across the landscape of mental health research and diagnosis, there is a diverse range of questionnaires and interviews available for use by clinicians and researchers to determine patient treatment plans or investigate internal and external etiologies. Although individually, these tools have each been assessed for their validity and reliability, there is little research examining the consistency between them in terms of what symptoms they assess, and how they assess those symptoms. Here, we provide an analysis of 126 different questionnaires and interviews commonly used to diagnose and screen for 10 different disorder types including depression, anxiety, obsessive compulsive disorder (OCD), posttraumatic stress disorder (PTSD), attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), addiction, bipolar disorder, eating disorder, and schizophrenia, as well as comparator questionnaires and interviews that offer an all-in-one cross-disorder assessment of mental health. We demonstrate substantial inconsistency in the inclusion and emphasis of symptoms assessed within disorders as well as considerable symptom overlap across disorder-specific tools. Within the same disorder, similarity scores across assessment tools ranged from 29% for assessment of bipolar disorder to a maximum of 58% for OCD. Furthermore, when looking across disorders, 60% of symptoms were assessed in at least half of all disorders illustrating the extensive overlap in symptom profiles between disorder-specific assessment tools. Biases in assessment toward emotional, cognitive, physical or behavioral symptoms were also observed, further adding to the heterogeneity across assessments. Analysis of other characteristics such as the time period over which symptoms were assessed, as well as whether there was a focus toward frequency, severity or duration of symptoms also varied substantially across assessment tools. The consequence of this inconsistent and heterogeneous assessment landscape is that it hinders clinical diagnosis and treatment and frustrates understanding of the social, environmental, and biological factors that contribute to mental health symptoms and disorders. Altogether, it underscores the need for standardized assessment tools that are more disorder agnostic and span the full spectrum of mental health symptoms to aid the understanding of underlying etiologies and the discovery of new treatments for psychiatric dysfunction.

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Section: The Potential Of Cross-disorder Assessmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Heterogeneity of Mental Health Assessment

Newson¹,

Hunter²,

Thiagarajan³

2020

Front. Psychiatry

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“…Over the past two decades the field has witnessed a remarkable increase in interest on biomarkers for mental disorders 6 . In particular, the literature on non-genetic peripheral biomarkers has grown exponentially, with the publication of several systematic reviews and metaanalyses [7][8][9][10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

“…For instance, it has been proposed that conventional psychiatric diagnoses based, for example, on the Diagnostic and Statistical Manual for Mental Disorders (DSM) may lack biological validity 2,13 . In this respect, it has been proposed that similarly to genetic 14 and neuroimaging 15,16 biomarkers, alterations in peripheral biomarkers for major mental disorders may be shared across distinct diagnostic categories, and thus may have a transdiagnostic nature 6 . However, what is a transdiagnostic construct in psychiatry remains debated, and no study has properly assessed the trans-diagnostic nature of any biomarker with a methodologically sound approach 17 .…”

Section: Introductionmentioning

confidence: 99%

Evidence-based umbrella review of 162 peripheral biomarkers for major mental disorders

et al. 2020

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The literature on non-genetic peripheral biomarkers for major mental disorders is broad, with conflicting results. An umbrella review of meta-analyses of non-genetic peripheral biomarkers for Alzheimer's disease, autism spectrum disorder, bipolar disorder (BD), major depressive disorder, and schizophrenia, including first-episode psychosis. We included meta-analyses that compared alterations in peripheral biomarkers between participants with mental disorders to controls (i.e., between-group meta-analyses) and that assessed biomarkers after treatment (i.e., withingroup meta-analyses). Evidence for association was hierarchically graded using a priori defined criteria against several biases. The Assessment of Multiple Systematic Reviews (AMSTAR) instrument was used to investigate study quality. 1161 references were screened. 110 met inclusion criteria, relating to 359 meta-analytic estimates and 733,316 measurements, on 162 different biomarkers. Only two estimates met a priori defined criteria for convincing evidence (elevated awakening cortisol levels in euthymic BD participants relative to controls and decreased pyridoxal levels in participants with schizophrenia relative to controls). Of 42 estimates which met criteria for highly suggestive evidence only five biomarker aberrations occurred in more than one disorder. Only 15 meta-analyses had a power >0.8 to detect a small effect size, and most (81.9%) meta-analyses had high heterogeneity. Although some associations met criteria for either convincing or highly suggestive evidence, overall the vast literature of peripheral biomarkers for major mental disorders is affected by bias and is underpowered. No convincing evidence supported the existence of a transdiagnostic biomarker. Adequately powered and methodologically sound future large collaborative studies are warranted.

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“…In April 6 th of this year, my coauthors and I submitted a systematic review of peripheral biomarkers in multiple psychiatric disorders to a scientific journal specializing in reviews in the neuroscience field. The work had already been available as a preprint in an open repository for a while (Pinto et al 2016), attracting a reasonable amount of attention -since November 2016, it has accumulated more than 2,000 views, more than 400 downloads and a number of tweets. Nevertheless, for the sake of making it more visible, as well as for it to be counted by funding agency evaluations, we decided to submit to a formal journal as well.…”

mentioning

confidence: 99%