Charting the landscape of priority problems in psychiatry, part 1: classification and diagnosis
Open accessAbstract
Contemporary psychiatry faces major challenges. Its syndrome-based disease classification is not based on mechanisms and does not guide treatment, which largely depends on trial and error. The development of therapies is hindered by ignorance of potential beneficiary patient subgroups. Neuroscientific and genetics research have yet to affect disease definitions or contribute to clinical decision making. In this challenging setting, what should psychiatric research focus on? In two companion papers, we present a list of problems nominated by clinicians and researchers from different disciplines as candidates for future scientific investigation of mental disorders. These problems are loosely grouped into challenges concerning nosology and diagnosis (this Personal View) and problems related to pathogenesis and aetiology (in the companion Personal View). Motivated by successful examples in other disciplines, particularly the list of Hilbert's problems in mathematics, this subjective and eclectic list of priority problems is intended for psychiatric researchers, helping to re-focus existing research and providing perspectives for future psychiatric science.
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Enduring dyshomoeostasis induces high-order beliefs about lack of control and low self-efficacy.
“This leads us to a key hypothesis of this paper—that “enduring dyshomoeostasis induces high-order beliefs about lack of control and low self-efficacy” (Stephan et al., 2016a).”
From Allostatic Self-efficacy: A Metacognitive Theory of Dyshomeostasis-Induced Fatigue and Depression (2016) · cites this paper as Stephan et al., 2016a
Differential diagnosis could be implemented formally by model selection, evaluating the evidence of different models that assume a disturbance at different branches and are fitted to electrophysiological or fMRI data from an individual patient.
“In our approach, such differential diagnosis could be implemented formally by model selection, i.e., evaluating the evidence of different models that assume a disturbance at different branches and are fitted to electrophysiological or fMRI data from an individual patient (cf. Stephan et al., 2016a).”
From Allostatic Self-efficacy: A Metacognitive Theory of Dyshomeostasis-Induced Fatigue and Depression (2016) · cites this paper as Stephan et al., 2016a
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- Authors
- Stephan, K. E., Bach, D. R., Fletcher, P. C., Flint, J., Frank, M. J., Friston, K. J., Heinz, A., Huys, Q. J. M., Owen, M. J., Binder, E. B., Dayan, P., Johnstone, E. C., Meyer-Lindenberg, A., Montague, P. R., Schnyder, U., Wang, X.-J., & Breakspear, M.
- Affiliations
- Wellcome Centre for Human Neuroimaging (GB)
- University of Cambridge (GB)
- Brown University (US)
- Humboldt-Universität zu Berlin (DE)
- University of Zurich (CH)
- Cardiff University (GB)
- Emory University (US)
- Gatsby Computational Neuroscience Unit (GB)
- University of Edinburgh (GB)
- New York University Shanghai (CN)
- Corresponding author
- Stephan, Klaas E
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 3
- Issue
- 1
- Pages
- 77-83
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W2135748590
- Cited by
- 180
- References
- 17
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 14 · 2023: 13 · 2022: 14 · 2021: 24 · 2020: 32 · 2019: 24 · 2018: 12 · 2017: 18 · 2016: 12 · 2015: 1
- FWCI
- 44.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The Lancet Psychiatry (acceptedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion)
- Max Planck Digital Library (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- MPG.PuRe (Max Planck Society) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- National Health and Medical Research Council (1037196)
- Wellcome Trust (503147)
- Deutsche Forschungsgemeinschaft (1617)
- Medical Research Council (G0800509, G0801418)
- Gatsby Charitable Foundation
- German Ministry of Research and Education
- EU Horizon 2020
- EU FP7
- ERC (281338)
- Innovative Medicine Initiative program
- Prix Robert de Spoelberch
- National Institutes of Health (R01MH062349)
- Office of Naval Research (N00014–13–1-0297)
- NHMRC (APP1037196)
- René and Susanne Braginsky Foundation
- University of Zurich
- Topics
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Keywords
- psychiatric classification, psychiatric diagnosis, disease classification, pathogenesis, etiology of mental disorders, research priorities, Hilbert's problems, patient subgroups
- MeSH terms
- Mental Disorders, Humans, Psychiatry, Research
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