Transdiagnostic psychiatry: a systematic review

World Psychiatry - Tập 18 Số 2 - Trang 192-207 - 2019
Paolo Fusar‐Poli1,2,3, Marco Solmi2,4, Natascia Brondino1, Cathy Davies2, Chungil Chae5, Pierluigi Politi1, Stefan Borgwardt6, Stephen M. Lawrie7, Josef Parnas8, Philip McGuire9,10,3
1Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
2Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
3OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
4Neuroscience Department, Psychiatry Unit University of Padua Padua Italy
5Applied Cognitive Science Lab, Department of Information Science and Technology Pennsylvania State University, University Park PA USA
6Department of Psychiatry, University of Basel, Basel, Switzerland
7Division of Psychiatry, University of Edinburgh, Edinburgh, UK
8Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
9Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience King's College London London UK
10National Institute for Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK

Tóm tắt

The usefulness of current psychiatric classification, which is based on ICD/DSM categorical diagnoses, remains questionable. A promising alternative has been put forward as the “transdiagnostic” approach. This is expected to cut across existing categorical diagnoses and go beyond them, to improve the way we classify and treat mental disorders. This systematic review explores whether self‐defining transdiagnostic research meets such high expectations. A multi‐step Web of Science literature search was performed according to an a priori protocol, to identify all studies that used the word “transdiagnostic” in their title, up to May 5, 2018. Empirical variables which indexed core characteristics were extracted, complemented by a bibliometric and conceptual analysis. A total of 111 studies were included. Most studies were investigating interventions, followed by cognition and psychological processes, and neuroscientific topics. Their samples ranged from 15 to 91,199 (median 148) participants, with a mean age from 10 to more than 60 (median 33) years. There were several methodological inconsistencies relating to the definition of the gold standard (DSM/ICD diagnoses), of the outcome measures and of the transdiagnostic approach. The quality of the studies was generally low and only a few findings were externally replicated. The majority of studies tested transdiagnostic features cutting across different diagnoses, and only a few tested new classification systems beyond the existing diagnoses. About one fifth of the studies were not transdiagnostic at all, because they investigated symptoms and not disorders, a single disorder, or because there was no diagnostic information. The bibliometric analysis revealed that transdiagnostic research largely restricted its focus to anxiety and depressive disorders. The conceptual analysis showed that transdiagnostic research is grounded more on rediscoveries than on true innovations, and that it is affected by some conceptual biases. To date, transdiagnostic approaches have not delivered a credible paradigm shift that can impact classification and clinical care. Practical “TRANSD”iagnostic recommendations are proposed here to guide future research in this field.

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World Psychiatry

Tập 18 Số 2

192-207

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