Operationalizing NIMH Research Domain Criteria (RDoC) in naturalistic clinical settings

Abstract

Recently, the National Institute of Mental Health (NIMH) introduced the Research Domain Criteria (RDoC) initiative to address two major challenges facing the field of psychiatry: (1) the lack of new effective personalized treatments for psychiatric disorders, and (2) The need for RDoCEffective treatments and policies are lacking for adolescents and adults with serious mental illness (SMI; i.e., treatment refractory neuropsychiatric disorders). Because tightly controlled efficacy studies restrict the capacity to provide personalized care, they may also restrict treatment response. Moreover, health insurance and public sector mental healthcare systems rarely allow for more than very brief psychiatric hospitalizations to focus primarily on stabilization. Thus, the majority of people with SMI are not afforded the time in treatment necessary to understand and treat their complex clinical symptoms and functional impairments.Offering personalized care means recognizing that for reasons of genetic makeup and personal history, people respond differentially to specific treatments and that poor response to one treatment does not necessarily imply poor response to another, or deny the possibility of potentiation through combinations of multimodal treatments over time.In addition to the challenges facing personalized clinical care for SMI, the publication of the 5 th edition of the Diagnostic and Statistical Manual for Mental Disorders in 2013 by the American Psychiatric Association was preceded by controversy and contentious debate (Regier, 2007a(Regier, , 2007bSaunders, 2006;Widiger & Simonsen, 2005). Despite the hopes that the practice of psychiatric diagnosis would be revolutionized, the knowledge base in the field was not judged sufficient to justify moving beyond the established tradition of diagnosing mental disorders based on clinical observation and patients' phenomenological symptom reports. In addition, the polythetic and dichotomous (categorical) diagnostic system was, for the most part, retained. In psychiatry (unlike other disciplines in medicine) we rely solely on the patient's subjective report, and on clinical observation, for diagnosis and treatment planning. In other words one could say that in psychiatry the disease is diagnosed as the symptom. Thus anxiety, for instance, is both the 4 4 diagnosis and its symptom. In general medicine, by contrast, when a patient presents with excessive thirst and frequent restroom breaks, the physician might order a blood glucose level test to confirm or dispute a diagnosis of diabetes, acknowledging that the behavioral phenotype (excessive thirst and frequent restroom breaks) may be associated with a variety of underlying conditions and that a direct mapping of subjective patient report to pathophysiology may clarify the disorder. In psychiatry, when a patient presents with anger outbursts, affective instability, a history of suicide attempts, alcohol abuse and relationship problems, he/she meets five out of nine DSM-5 criteria for borderline personality disorde...

The roles of early-life adversity and rumination in neural response to emotional faces amongst anxious and depressed adults

“…Seeing as ELA constitutes risk for a number of IPs (Widom et al ., 2007; Gilbert et al ., 2009) and in alignment with the Research Domain Criteria initiative to understand how biologically based constructs explain the core, shared features of diagnostic categories (Cuthbert, 2015), linking neural phenotypes of ELA to patterns of thought or behavior common to IPs is also of substantial clinical utility (Insel, 2014; Sharp et al ., 2016). One shared feature of IPs is rumination (Nolen-Hoeksema and Watkins, 2011), a maladaptive cognitive style, defined as the tendency to constantly focus on a negative thought, problem, or mood state and on the possible causes and implications of negative feelings (Smith and Alloy, 2009).…”

Neuropsychologische Störungen bei coronavirusassoziierten Erkrankungen

“…Darüber hinaus ist eine therapiezielorientierte Optimierung der klassifi katorischen Diagnostik wünschenswert, welche die neuropathologischen Mechanismen der Störung mitberücksichtigt (vgl. RDoC; Sharp et al, 2016) Da die Störungen bezüglich Dauer, Ätiologie und Schweregrad sehr heterogen und die Bandbreite möglicher Maßnahmen groß sind, erscheint es sinnvoll, evidenzbasiert Fallgruppen zu entwickeln, um qualitativ und quantitativ unterschiedlich stark betroff ene Individuen verschiedenen Behandlungsplänen zuweisen zu können. Dabei erscheint es sinnvoll, in Anlehnung an die Klassifikation anderer chronisch adverser Zustände (vgl.…”

“…Möglicherweise beantworten diese Ansätze die Fragen nach möglichen Gründen, Verläufen und Erfolgsaussichten von Rehabilitationsbehandlungen nicht vollständig. Die Bewertung der COVID-19-Folgestörungen könnte möglicherweise verbessert werden, indem die Vorschläge, welche aus dem RDoC hervorgegangenen sind, auch im Bereich der COVID-19-Folgeerkrankungen berücksichtigt würden: Statt deskriptiver Kategorisierungen sollte die Konzeptbildung auf Grundlage verhaltensneurowissenschaftlicher Konstrukte erfolgen (Sharp et al, 2016). Biomedizinische und psychische Gesundheitseff ekte sollen laut RDoC im selben Bezugssystem abgebildet werden.…”

Empirically supported interventions in psychology: contributions of Research Domain Criteria

“…However, operationalizing RDoC principles in naturalistic settings is challenging (Sharp et al, 2016).…”