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Tijdschrift voor Psychiatrie 56 (2014) 10, 670 - 679

Essay

A fresh look at psychiatric disorders

P.J.M. van Wijngaarden-Cremers, P. van Deurzen, I. Oosterling, W. Groen, M. Langen, A.L. Lagro-Janssen, R.J. van der Gaag

background The a-theoretical approach to psychiatric disorders, introduced via dsm iii, has had a tremendous impact. It has stimulated a large body of research, facilitated by the concurrent development of new techniques in genetics, neuro-imaging and neuropsychology. However, the research results of the last twenty years or so have cast doubt on the validity of the clinical categories set out in dsm iii.
aim To develop a new view on developmental pathways in psychopathology, clinical assessment and scientifically acceptable classification.
method In this article we review the state of the art with regard to underlying endophenotypes at the level of brain and neurotransmitter functioning and neuropsychology and we consider the effect of social determinants on the developments of psychopathology.
results Our results show that neither genotypes and endophenotypes, nor brain mechanism, nor neuropsychological deviances have a one-to-one correlation with clinical categories as defined in even the dsm 5.
conclusion dsm-5 provides a range of possibilities for classifying psychiatric disorders at symptom level. But these categories seem to be less distinct than was at first assumed. Recent research has shown that there is a great deal of overlap at the genetic, epigenetic and endophenotype level. This calls for more emphasis on individual assessment and diagnostics in both clinical practice and scientific research. More attention needs to be given to the dimensions of emotion and behavior, vulnerability and resilience. This type of approach, involving genotypes, endophenotypes, epigenetics and brainfunctioning, could help to elucidate the interaction between these various levels and/or explain the underlying mechanisms of psychiatric disorders.

keywords classification, genetics, neuropsychology, neuro-imaging