Defining psychopathology in the 21st century : DSM-V and beyond
The American Psychopathological Association (APPA) has a rich history of interest in and contributions to the taxonomies that have been used in medicine to define psychopathology. From Adolf Meyer to commonsense psychiatry to current members’ contributions refining the DSM through the use of basic and clinical research, members of the APPA have often taken the lead in the development of psychiatric taxonomies. This volume, coordinated from the annual meeting in 2000, “Defining Psychopathology in the 21st Century,” is devoted to this topic. The hope for the millennium meeting and for this resulting volume is that they will challenge debate about the tensions between the convenience of a clinically derived categorical taxonomy and the growing research need for more empirically derived, dimensional systems.
The author of Chapter 1 of this volume, Robert Kendell, who wrote brilliantly about the need for categories in his book The Role of Diagnosis in Psychiatry, was also challenging us to think more dimensionally as far back as the 1970s. Obviously, this is hardly a new issue in psychopathology. However, there is growing concern that broad categories of illness are insufficient to serve new research needs, perhaps most acutely in genetics research.
Within this text are 15 chapters devoted to the goal of developing approaches to classification that will lead to more accurate diagnoses and treatments for our patients and to a broader range of taxonomic options for research. We have devoted 4 chapters to “Definitional Tensions,” in which among other topics, Dr. Kendell presents a list of five criteria for a better taxonomy. It appears certain that the advances in neuroimaging will forever change the conceptualization of “disorder” in psychiatry.
Thus, we committed a number of chapters to the contribution of imaging studies to improving our diagnostic approaches. Too little attention has been paid to the developmental/longitudinal contribution to diagnostic considerations; hence, we included meaningful discussions of collecting data over time. With the publication of the human genome sequence and the assurance that a large number of the genes yet to be defined will be genes that contribute to behavior, we devoted 4 chapters to the consideration of genetic epidemiology in subjects of all ages and both genders to develop, as Dr. Faraone argues, “a genetically meaningful taxonomy.”
This was both a sweet and sad conference for us. Our science has never been more exciting or important. We were able to honor two of our members with awards that recognize their long contribution to the field and to the APPA. Dr. Stephen Faraone presented Dr. Ming T. Tsuang with the Paul Hoch Award, recognizing his lifelong contribution to psychiatric genetics. In his presentation and in his chapter in this volume. Dr. Tsuang argued for using our new methodologies in the consideration of treating subsyndromal or preschizophrenia, a taxonomic condition he defines as “schizotaxia.”
For many of us, this was the last time we spent with Dr. Samuel B. Guze, who was honored with this year’s Joseph Zubin Award. Dr. Guze and his work have touched almost all members of the APPA. and it is for this reason that we mark his passing by dedicating this volume to him.
Part I Definitional Tensions
1 Five Criteria for an Improved Taxonomy of Mental Disorders / Robert E. Kendell, M.D.
2 Defining Clinically Significant Psychopathology With Epidemiologic Data / Darrel A. Regier, M.D., M.P.H., and William E. Narrow, M.D., M.P.H.
3 Why Requiring Clinical Significance Does Not Solve Epidemiology’s and DSM’s Validity Problem: Response to Regier and Narrow / Jerome C. Wakefield, D.S.W., Ph.D., and Robert L. Spitzer, M.D.
4 Psychometric Perspectives on Comorbidity / Robert F. Krueger; Ph.D.
Part II Imaging Psychopathology
5 Toward a Neuroanatomical Understanding of Psychiatric Illness: The Role of Functional Imaging / Jane Epstein, M.D., Nancy Isenberg, M.D., M.P.H., Emily Stern, M.D., and David Silbersweig, M.D.
6 Neuroimaging Studies of Mood Disorders / Wayne C. Drevets, M.D.
7 Genetic Neuroimaging: Helping to Define Phenotypes in Affective Disorders / Kelly N. Botteron, M.D.
Part III Longitudinal Studies
8 Psychopathology and the Life Course / Stephen L. Buka, Sc.D., and Stephen E. Gilman, Sc.D.
9 Detecting Longitudinal Patterns of Alcohol Use / John E. Helzer, M.D., and John S. Searles, Ph.D.
10 Empirically Based Assessment and Taxonomy Across the Life Span / Thomas M. Achenbach, Ph.D.
11 ADHD Comorbidity Findings From the MTA Study: New Diagnostic Subtypes and Their Optimal Treatments / Peter S. Jensen, M.D., and Members of the MTA Cooperative Group
Part IV Exploring Alternatives
12 Implications of Genetic Epidemiology for Classification / Kathleen R. Merikangas, Ph.D.
13 Importance of Phenotype Definition in Genetic Studies of Child Psychopathology /
James J. Hudziak, M.D.
14 Defining Genetically Meaningful Classes of Psychopathology / Stephen V Faraone, Ph.D.
15 Schizotaxia and the Prevention of Schizophrenia / Ming T. Tsuang, M.D., Ph.D.
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