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Diagnostic Fluidity: Inter- and Intra-Disease Considerations
Abstract
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Traditionally, psychopathology has been classified based on the publications of authoritative bodies, such as the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (APA's DSM). Recently, researchers have expressed an interest in basing classification more on data, as opposed to authority. This movement led to the formation of the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium. Working from data, the HiTOP approach emphasizes dimensions of human individual differences that are arranged hierarchically, as opposed to categories that are arranged based on traditional DSM chapter rubrics. In this talk, I will describe the origins and status of the HiTOP approach, as well as current and future HiTOP directions and priorities.
Shared Genetic Aetiology of Psychiatric Diseases
Abstract
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Mental disorders have overlapping symptom and signs, and hare heritable complex disorders with polygenic architecture. Futher, there are widespread genetic overlap across multiple disorders and related traits. However, currently the shared genetic determinants of complex traits and disorders are now known..We have developed novel tools to study the overlapping genetic architecture.
We used novel statistical genetics tools to investigate the genetic architecture of severe mental disorders and related mental traits (personality, education and general cognition). The MiXeR model estimates the total number of variants for a given trait (polygenicity) and shared between two traits (bivariate), alongside genetic correlation. Here we investigated of four mental disorders, two cognitive traits, two personality traits and height from large samples (n=53,293-766,345).
There was a variation in the polygenicity of mental disorders, with ADHD least polygenic (5.6K variants), followed by bipolar disorder (8.6K), schizophrenia (9.6K) and major depression (13.2K). Interestingly, a large proportion of genetic variants were shared across mental disorders and between mental disorders and brain-related traits, including general cognition and personality traits. There was limited overlap with height.
Discussion: The extensive genetic overlap across mental disorders and behavioral and cognitive traits indicate that their genetic architectures are shared, and influenced by different patterns of effects differentiating diagnostic categories. This suggest a new approach to understanding the complex genetic risk of mental disorders, which may inform further genetic discovery, gene x environment interplay, as well biological understanding. It could also lead to revisions in psychiatric nosology.
The Concept of Transdiagnostic Psychiatry