Journal article
Combining clinical stage and pathophysiological mechanisms to understand illness trajectories in young people with emerging mood and psychotic syndromes
Medical Journal of Australia, Vol.211(Supplement 9), pp.S12-S22
2019
Appears in Thompson Institute Research Collection
Abstract
Traditional diagnostic classification systems for mental disorders map poorly onto the early stages of illness experienced by young people, and purport categorical distinctions that are not readily supported by research into genetic, environmental and neurobiological risk factors. Consequently, a key clinical challenge in youth mental health is to develop and test new classification systems that align with current evidence on comorbid presentations, are consistent with current understanding of underlying neurobiology, and provide utility for predicting outcomes and guiding decisions regarding the provision of appropriate and effective care. This chapter outlines a transdiagnostic framework for classifying common adolescent-onset mood and psychotic syndromes, combining two independent but complementary dimensions: clinical staging, and three proposed pathophysiological mechanisms. Clinical staging reflects the progression of mental disorders and is in line with the concept used in general medicine, where more advanced stages are associated with a poorer prognosis and a need for more intensive interventions with a higher risk-to-benefit ratio. The three proposed pathophysiological mechanisms are neurodevelopmental abnormalities, hyperarousal and circadian dysfunction, which, over time, have illness trajectories (or pathways) to psychosis, anxious depression and bipolar spectrum disorders, respectively. The transdiagnostic framework has been evaluated in young people presenting to youth mental health clinics of the University of Sydney's Brain and Mind Centre, alongside a range of clinical and objective measures. Our research to date provides support for this framework, and we are now exploring its application to the development of more personalised models of care.
Details
- Title
- Combining clinical stage and pathophysiological mechanisms to understand illness trajectories in young people with emerging mood and psychotic syndromes
- Authors
- Joanne S Carpenter (Corresponding Author) - University of SydneyFrank Iorfino (Corresponding Author) - University of SydneyShane P Cross (Corresponding Author) - University of SydneyTracey A Davenport (Author) - University of SydneyDaniel F Hermens (Author) - University of the Sunshine Coast - Thompson InstituteCathrin Rohleder (Corresponding Author) - University of SydneyJacob J Crouse (Author) - University of SydneyF Markus Leweke (Author) - University of SydneyDagmar Koethe (Author) - University of SydneyAdam J Guastella (Author) - University of SydneySharon L Naismith (Author) - University of SydneyJan Scott (Author) - University of SydneyElizabeth M Scott (Author) - University of SydneyIan B Hickie (Corresponding Author) - University of Sydney
- Publication details
- Medical Journal of Australia, Vol.211(Supplement 9), pp.S12-S22
- Publisher
- Wiley-Blackwell Publishing Asia
- Date published
- 2019
- DOI
- 10.5694/mja2.50383
- ISSN
- 0025-729X
- Organisation Unit
- University of the Sunshine Coast, Queensland; Thompson Institute
- Language
- English
- Record Identifier
- 99450975002621
- Output Type
- Journal article
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- Domestic collaboration
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- Psychiatry
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Source: InCites