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2.
J Alzheimers Dis ; 58(2): 449-462, 2017.
Article in English | MEDLINE | ID: mdl-28453472

ABSTRACT

Presented herein is evidence for criterion, content, and convergent/discriminant validity of the NIMH-Provisional Diagnostic Criteria for depression of Alzheimer's Disease (PDC-dAD) that were formulated to address depression in Alzheimer's disease (AD). Using meta-analytic and systematic review methods, we examined criterion validity evidence in epidemiological and clinical studies comparing the PDC-dAD to Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV), and International Classification of Disease (ICD 9) depression diagnostic criteria. We estimated prevalence of depression by PDC, DSM, and ICD with an omnibus event rate effect-size. We also examined diagnostic agreement between PDC and DSM. To gauge content validity, we reviewed rates of symptom endorsement for each diagnostic approach. Finally, we examined the PDC's relationship with assessment scales (global cognition, neuropsychiatric, and depression definition) for convergent validity evidence. The aggregate evidence supports the validity of the PDC-dAD. Our findings suggest that depression in AD differs from other depressive disorders including Major Depressive Disorder (MDD) in that dAD is more prevalent, with generally a milder presentation and with unique features not captured by the DSM. Although the PDC are the current standard for diagnosis of depression in AD, we identified the need for their further optimization based on predictive validity evidence.


Subject(s)
Alzheimer Disease/complications , Alzheimer Disease/epidemiology , Depression , National Institute of Mental Health (U.S.)/standards , Databases, Bibliographic/statistics & numerical data , Depression/diagnosis , Depression/epidemiology , Depression/etiology , Female , Humans , Longitudinal Studies , Male , Reproducibility of Results , United States
3.
Schizophr Bull ; 43(3): 503-508, 2017 05 01.
Article in English | MEDLINE | ID: mdl-28398574

ABSTRACT

Thought disorder is a pernicious and nonspecific aspect of numerous serious mental illnesses (SMIs) and related conditions. Despite decades of empirical research on thought disorder, our present understanding of it is poor, our clinical assessments focus on a limited set of extreme behaviors, and treatments are palliative at best. Applying a Research Domain Criteria (RDoC) framework to thought disorder research offers advantages to explicate its phenotype; isolate its mechanisms; and develop more effective assessments, treatments, and potential cures. In this commentary, we discuss ways in which thought disorder can be understood within the RDoC framework. We propose operationalizing thought disorder within the RDoC construct of language using psycholinguistic sciences, to help objectify and quantify language within individuals; technologically sophisticated paradigms, to allow naturalistic behavioral sampling techniques with unprecedented ecological validity; and computational modeling, to account for a network of interconnected and dynamic linguistic, cognitive, affective, and social functions. We also highlight challenges for understanding thought disorder within an RDoC framework. Thought disorder likely does not occur as an isomorphic dysfunction in a single RDoC construct, but rather, as multiple potential dysfunctions in a network of RDoC constructs. Moreover, thought disorder is dynamic over time and context within individuals. In sum, RDoC is a useful framework to integrate multidisciplinary research efforts aimed at operationalizing, understanding, and ameliorating thought disorder.


Subject(s)
Mental Disorders/classification , National Institute of Mental Health (U.S.)/standards , Thinking/physiology , Humans , United States
4.
J Psychiatr Pract ; 23(2): 130-133, 2017 03.
Article in English | MEDLINE | ID: mdl-28291038

ABSTRACT

There is a need for psychotherapy research to determine the effective, nonspecific or shared elements of psychotherapy regardless of therapy school. In an apparent "either/or" rather than "both/and" choice, the National Institute of Mental Health (NIMH) has committed its research resources to study of neural mechanisms and biomarkers, while greatly reducing funding for research into clinical methods, including psychotherapy. This column explores the potential effect of this decision on patient care and reviews questions raised by some about whether the underlying "big idea" behind the NIMH research approach is supported by the results of several decades of brain and genomics research. Patients are left to hope for clinically meaningful research findings concerning brain or gene mechanisms of mental disorders, as if they are just around the corner, when the actual benefit of such research likely remains decades away.


Subject(s)
Biomedical Research/standards , National Institute of Mental Health (U.S.)/standards , Psychotherapy , Biomedical Research/economics , Humans , National Institute of Mental Health (U.S.)/economics , United States
5.
J Clin Psychiatry ; 78(4): 423-432, 2017 Apr.
Article in English | MEDLINE | ID: mdl-28002661

ABSTRACT

Offering a new framework for understanding and studying basic dimensions of normal and abnormal human functioning and mental disorders, the National Institute of Mental Health (NIMH) has initiated the Research Domain Criteria (RDoC) project in which a series of higher order domains, representing major systems of emotion, cognition, motivation, and social behavior, and their constituent operationally defined constructs serve as organizing templates for further research and inquiry, eg, to discover validated biomarkers and endophenotypes. Cutting across traditional DSM diagnoses, the domains are defined as Negative Valence Systems, Positive Valence Systems, Cognitive Systems, Systems for Social Processes, and Arousal/Regulatory Systems. To inform educators, trainees, and practitioners about RDoC, alert them to potential practical applications, and encourage their broad exploration in clinical settings, this article reviews the RDoC domains and their subsystem constructs with regard to potential current clinical considerations and applications. We describe ways in which the RDoC domains and constructs offer transdiagnostic frameworks for complementing traditional practice; suggest clinical questions to help elucidate salient information; and, translating RDoC domains and constructs headings into clinically friendly language, offer a template for the psychiatric review of systems that can serve in clinical notes.


Subject(s)
Mental Disorders/diagnosis , Mental Disorders/therapy , National Institute of Mental Health (U.S.)/standards , Patient Care Planning , Humans , Mental Disorders/classification , United States
6.
J Affect Disord ; 216: 58-69, 2017 07.
Article in English | MEDLINE | ID: mdl-27823854

ABSTRACT

BACKGROUND: In 2010, the National Institute of Mental Health (NIMH) created the Research Domain Criteria (RDoC), a research framework for integrating multiple units of information to explicate basic dimensions of functioning underlying both adaptive and maladaptive behavior. Our goal in this review is to evaluate self-report indicators of negative valence systems constructs within RDoC. METHODS: We review the content and correlates of several of the most popular self-report measures currently classified within the negative valence systems in the RDoC matrix, using both our own data and previously published results. We use these data to evaluate whether these measures are appropriately placed; in addition, wherever possible, we recommend better alternatives to assess key RDoC constructs. RESULTS: Our findings indicate that many of the currently listed self-report measures are misplaced. Specifically, our data reveal that some of the purported fear scales are better conceptualized as measures of anxiety and/or anxious arousal. In addition, none of the currently listed measures of frustrative nonreward is a clear, unambiguous indicator of that construct. LIMITATIONS: The RDoC matrix currently does not list any specific measures of either loss or sustained threat, which makes it difficult to identify appropriate measures of these constructs. In many cases, the specificity/discriminant validity of proposed measures remains uncertain. CONCLUSIONS: Researchers wanting to include self-report measures of negative valence constructs currently receive little guidance from the RDoC matrix. Future assessment work should be oriented toward the development of measures that are explicitly designed to assess these RDoC constructs.


Subject(s)
Anxiety/diagnosis , Behavioral Research/standards , Self Report/standards , Symptom Assessment/standards , Anxiety/psychology , Arousal , Emotions , Fear , Humans , National Institute of Mental Health (U.S.)/standards , United States
7.
Bull Menninger Clin ; 80(3): 187-212, 2016.
Article in English | MEDLINE | ID: mdl-27583809

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 limitations associated with categorically defined psychiatric disorders. Although the potential of RDoC to revolutionize personalized psychiatric medicine and psychiatric nosology has been acknowledged, it is unclear how to implement RDoC in naturalistic clinical settings as part of routine outcomes research. In this article, the authors present the major RDoC principles and then show how these principles are operationalized in The Menninger Clinic's McNair Initiative for Neuroscience Discovery-Menninger & Baylor College of Medicine (MIND-MB) study. The authors discuss how RDoC-informed outcomes-based assessment in clinical settings can transform personalized clinical care through multimodal treatments.


Subject(s)
Mental Disorders/diagnosis , National Institute of Mental Health (U.S.)/standards , Outcome Assessment, Health Care/methods , Precision Medicine/methods , Psychiatry/methods , Adolescent , Adult , Female , Humans , Male , Mental Disorders/classification , Middle Aged , Outcome Assessment, Health Care/standards , Precision Medicine/standards , Psychiatry/standards , United States , Young Adult
9.
Annu Rev Clin Psychol ; 12: 435-63, 2016.
Article in English | MEDLINE | ID: mdl-26845519

ABSTRACT

Since at least the middle of the past century, one overarching model of psychiatric classification has reigned supreme, namely, that of the Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases and Related Health Problems (herein referred to as DSM-ICD). This DSM-ICD approach embraces an Aristotelian view of mental disorders as largely discrete entities that are characterized by distinctive signs, symptoms, and natural histories. Over the past several years, however, a competing vision, namely, the Research Domain Criteria (RDoC) initiative launched by the National Institute of Mental Health, has emerged in response to accumulating anomalies within the DSM-ICD system. In contrast to DSM-ICD, RDoC embraces a Galilean view of psychopathology as the product of dysfunctions in neural circuitry. RDoC appears to be a valuable endeavor that holds out the long-term promise of an alternative system of mental illness classification. We delineate three sets of pressing challenges--conceptual, methodological, and logistical/pragmatic--that must be addressed for RDoC to realize its scientific potential. We conclude with a call for further research, including investigation of a rapprochement between Aristotelian and Galilean approaches to psychiatric classification.


Subject(s)
Diagnostic and Statistical Manual of Mental Disorders , International Classification of Diseases , Mental Disorders/diagnosis , National Institute of Mental Health (U.S.)/standards , Vocabulary, Controlled , Humans , Mental Disorders/classification , United States
10.
J Am Acad Child Adolesc Psychiatry ; 55(2): 93-8, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26802775

ABSTRACT

OBJECTIVE: This review discusses the relevance of the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) to clinical research in child and adolescent psychiatry. METHOD: We summarize the characteristics of the NIMH RDoC project and then provide examples of RDoC designs that are of relevance to clinical investigators in child and adolescent psychiatry. The final section addresses questions regarding the impact of RDoC on clinical care. RESULTS: RDoC encourages investigators to investigate psychopathology dimensionally: greater or lesser degrees of healthy/adapted functioning of neurobiological, cognitive, and behavioral processes (constructs) that cut across current diagnostic categories. Elucidation of the developmental components of RDoC constructs is needed to ensure they are fully validated. Integrating RDoC approaches into clinical research of child and adolescent psychopathology is contributing to our understanding of development as an aspect of the heterogeneity within DSM disorders and commonalities across seemingly disparate disorders. Continued efforts promise to also explain the processes that lead to mental illness in at-risk populations. CONCLUSION: Incorporating an RDoC approach in clinical research in child and adolescent psychiatry promises to be a fruitful avenue of research into the root causes and manifestations of mental illness, which will eventually lead to more precise treatments. Although the long-term aspiration of RDoC is to help reduce the burden of suffering for those with mental illnesses, it is not intended to be used for practical clinical purposes at this early stage.


Subject(s)
Adolescent Psychiatry/methods , Child Psychiatry/methods , National Institute of Mental Health (U.S.)/standards , Adolescent , Adolescent Psychiatry/standards , Child , Child Psychiatry/standards , Diagnostic and Statistical Manual of Mental Disorders , Humans , Mental Disorders/diagnosis , Psychiatry/methods , Psychopathology/methods , Psychopathology/standards , United States
11.
J Clin Psychiatry ; 77(8): 1065-73, 2016 08.
Article in English | MEDLINE | ID: mdl-26580150

ABSTRACT

OBJECTIVE: To provide the first head-to-head test of the predictive validity of 2 resolution levels included in the current consensus definition of major depressive episode (MDE) recovery and provide an empirically based, clinically useful definition of the end of an MDE. METHOD: 322 participants entering the National Institute of Mental Health Collaborative Depression Study with MDE (diagnosed by Research Diagnostic Criteria) in 1978-1981, and followed thereafter for up to 31 years, were divided into those with 8 consecutive weeks of asymptomatic MDE recovery or residual subsyndromal depressive symptom (SSD) resolution of their index MDE. These 2 levels of recovery were defined based on weekly symptom status on all depressive conditions, assessed by Longitudinal Interval Follow-Up Evaluation (LIFE) interviews conducted every 6 months. Primary measures of validity of these 2 alternative definitions were first well interval duration and long-term depressive illness burden. Groups were also compared on clinical variables, antidepressant treatment, and psychosocial function. RESULTS: 61.2% of subjects recovered asymptomatically from their index MDE. By survival analysis, they remained free of a depressive episode relapse or recurrence 4.2 times longer than those with SSD resolution (median = 135 vs 32 weeks; χ² = 70.65; P < .0001). This was not attributable to a difference in intensity of antidepressant medication. Compared to asymptomatic recovery, SSD resolution was associated with significantly longer and more severe index MDEs, with more miscellaneous psychopathology as well as increased long-term psychosocial dysfunction and a greater depressive illness burden during the ensuing 10 or 20 years. Asymptomatic MDE resolution was a stronger predictor of time well than any of 18 other predictors, singly or combined. Eight consecutive weeks of asymptomatic recovery had 93% overlap with a 4-week definition and conferred little benefit over 4 weeks. CONCLUSIONS: Four consecutive weeks of asymptomatic recovery defines the end of an MDE and the beginning of a stable well state with improved psychosocial function. Residual symptom resolution is a continuation of an active state of the episode, not the end of an MDE.


Subject(s)
Consensus , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/therapy , National Institute of Mental Health (U.S.)/standards , Outcome Assessment, Health Care/standards , Adult , Aged , Female , Humans , Longitudinal Studies , Male , Middle Aged , Recurrence , Remission Induction , Reproducibility of Results , United States
12.
J Nerv Ment Dis ; 204(1): 26-32, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26704462

ABSTRACT

The National Institute of Mental Health is actively promoting Research Domain Criteria as a new model for the research on mental disorders. Research Domain Criteria approaches disorders through a matrix, linking units of analysis with domains, based on the assumption that psychopathology reflects abnormal connectivity in the brain. This review suggests that the Research Domain Criteria perspective is likely to fail to provide an adequate basis for clinical psychiatric theory and practice. First, it uses models from neuroscience that are insufficiently developed. Second, it is based on the premise that mental phenomena and mental disorders can be reduced to neural activity, without consideration of cognition, experience, and social interaction. Third, it downplays psychosocial factors in psychopathology and treatment. Research Domain Criteria may therefore prove inadequate for providing a neuroscientific basis for psychiatric nosology and treatment and needs to be supplemented with a broader view that incorporates insights from social sciences, psychology, and phenomenology.


Subject(s)
Biomedical Research/standards , Mental Disorders/classification , Mental Disorders/diagnosis , National Institute of Mental Health (U.S.)/standards , Psychiatry/standards , Humans , United States
14.
Curr Psychiatry Rep ; 16(12): 515, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25308387

ABSTRACT

The DSM-5 creation process and outcome underlines a core tension in psychiatry between empirical evidence that mental pathologies tend to be dimensional and a historical emphasis on delineating categorical disorders to frame psychiatric thinking. The DSM has been slow to reflect dimensional evidence because doing so is often perceived as a disruptive paradigm shift. As a result, other authorities are making this shift, circumventing the DSM in the process. For example, through the Research Domain Criteria (RDoC), NIMH now encourages investigators to focus on a dimensional and neuroscientific conceptualization of mental disorder research. Fortunately, the DSM-5 contains a dimensional model of maladaptive personality traits that provides clinical descriptors that align conceptually with the neuroscience-based dimensions delineated in the RDoC and in basic science research. Through frameworks such as the DSM-5 trait model, the DSM can evolve to better incorporate evidence of the dimensionality of mental disorder.


Subject(s)
Diagnostic and Statistical Manual of Mental Disorders , Mental Disorders/classification , Mental Disorders/diagnosis , National Institute of Mental Health (U.S.)/standards , Humans , United States
16.
Acad Psychiatry ; 38(2): 121-3, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24619911

ABSTRACT

The National Institute of Mental Health seeks to address the gap between modern neuroscience and psychiatric training. The authors describe a two-pronged approach: first, to identify and support trainees in clinical neuroscience and second, to promote neuroscience literacy in psychiatric residency programs.


Subject(s)
Fellowships and Scholarships/standards , Internship and Residency/standards , Neurosciences/education , Psychiatry/education , Accreditation/standards , Fellowships and Scholarships/economics , Humans , Internship and Residency/economics , National Institute of Mental Health (U.S.)/economics , National Institute of Mental Health (U.S.)/standards , Neurosciences/standards , Professional Competence/standards , Psychiatry/standards , United States
18.
Acad Psychiatry ; 38(2): 145-50, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24493358

ABSTRACT

OBJECTIVE: Clinical and neurobiological data suggest that psychiatric disorders, as traditionally defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), are (1) more comorbid than expected by chance, (2) often share neurobiological signatures, and (3) reflect alterations across multiple brain systems that mediate particular mental processes. As such, emerging conceptualizations such at the National Institute of Mental Health's Research Domain Criteria Project (RDoC) have suggested that a different way to understand psychopathology may be with respect to the degree of dysfunction in each of these brain systems, seen dimensionally, which both cross traditional diagnostic boundaries and extend to a healthy range of functioning. At present, however, this scientific perspective has not been incorporated into neuroscience education in psychiatry, nor has its relationship to clinical care been made clear. METHODS: We describe the rationale and implementation of a reformulated neuroscience course given to psychiatric residents at Stanford University centered on the conceptual framework of RDoC. Data are presented on resident feedback before and after revision of the course. RESULTS: A clear motivation and rationale exists for teaching neuroscience in a transdiagnostic framework. This course was taken up well by the residents, with overall feedback significantly more positive than that prior to the course revision. CONCLUSION: This "proof of concept" neuroscience course illustrates a potential route for bridging between rapid advances in psychiatric neuroscience and the clinical education for trainees not otherwise versed in neuroscience but who are needed for scientific advances to translate to the clinic. The promise of this approach may be in part related to the similarity between this framework and problem-based approaches common in routine clinical care. In such approaches, clinicians focus on the expressed complaints of their individual patient and identify specific symptoms as the target of treatment--symptoms which are presumably the expression of dysfunction in specific brain systems.


Subject(s)
Internship and Residency/standards , Mental Disorders/classification , Neurosciences/education , Psychiatry/education , Curriculum/standards , Diagnostic and Statistical Manual of Mental Disorders , Humans , National Institute of Mental Health (U.S.)/standards , United States
19.
Neuron ; 80(3): 561-7, 2013 Oct 30.
Article in English | MEDLINE | ID: mdl-24183009

ABSTRACT

As directors of two NIH institutes supporting neuroscience research, we explore the gap between 25 years of stunning progress in fundamental neuroscience and the persistent needs of those with brain disorders. We conclude that closing this gap will require a more detailed comprehension of brain function, a rethinking of how we approach translational science, a focus on human neurobiology, and a continuing commitment to build a diverse, innovative neuroscience workforce. In contrast to many other areas of medicine, we lack basic knowledge about our organ of interest. The next phase of progress on brain disorders will require a significantly deeper understanding of fundamental neurobiology.


Subject(s)
National Institute of Mental Health (U.S.) , National Institute of Neurological Disorders and Stroke (U.S.) , Animals , History, 20th Century , History, 21st Century , Humans , National Institute of Mental Health (U.S.)/history , National Institute of Mental Health (U.S.)/standards , National Institute of Mental Health (U.S.)/trends , National Institute of Neurological Disorders and Stroke (U.S.)/history , National Institute of Neurological Disorders and Stroke (U.S.)/standards , National Institute of Neurological Disorders and Stroke (U.S.)/trends , United States
20.
JAMA Psychiatry ; 70(12): 1363-71, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24173618

ABSTRACT

IMPORTANCE: Risk communication and management are essential to the ethical conduct of research, yet addressing risks may be time consuming for investigators and institutional review boards may reject study designs that seem too risky. This can discourage needed research, particularly in higher-risk protocols or those enrolling potentially vulnerable individuals, such as those with some level of suicidality. Improved mechanisms for addressing research risks may facilitate much needed psychiatric research. OBJECTIVE: To provide mental health researchers with practical approaches to (1) identify and define various intrinsic research risks, (2) communicate these risks to others (eg, potential participants, regulatory bodies, and society), (3) manage these risks during the course of a study, and (4) justify the risks. EVIDENCE REVIEW: As part of a National Institute of Mental Health-funded scientific meeting series, a public conference and a closed-session expert panel meeting were held on managing and disclosing risks in mental health clinical trials. The expert panel reviewed the literature with a focus on empirical studies and developed recommendations for best practices and further research on managing and disclosing risks in mental health clinical trials. No institutional review board-review was required because there were no human subjects. FINDINGS: Challenges, current data, practical strategies, and topics for future research are addressed for each of 4 key areas pertaining to management and disclosure of risks in clinical trials: identifying and defining risks, communicating risks, managing risks during studies, and justifying research risks. CONCLUSIONS AND RELEVANCE: Empirical data on risk communication, managing risks, and the benefits of research can support the ethical conduct of mental health research and may help investigators better conceptualize and confront risks and to gain institutional review board-approval.


Subject(s)
Biomedical Research/standards , Clinical Trials as Topic/standards , Mental Health/standards , Risk Assessment/standards , Ethics Committees, Research/standards , Guidelines as Topic/standards , Humans , Informed Consent/standards , National Institute of Mental Health (U.S.)/standards , United States
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