Fusar-Poli Paolo, Solmi Marco, Brondino Natascia, Davies Cathy, Chae Chungil, Politi Pierluigi, Borgwardt Stefan, Lawrie Stephen M, Parnas Josef, McGuire Philip
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK.
World Psychiatry. 2019 Jun;18(2):192-207. doi: 10.1002/wps.20631.
The usefulness of current psychiatric classification, which is based on ICD/DSM categorical diagnoses, remains questionable. A promising alternative has been put forward as the "transdiagnostic" approach. This is expected to cut across existing categorical diagnoses and go beyond them, to improve the way we classify and treat mental disorders. This systematic review explores whether self-defining transdiagnostic research meets such high expectations. A multi-step Web of Science literature search was performed according to an a priori protocol, to identify all studies that used the word "transdiagnostic" in their title, up to May 5, 2018. Empirical variables which indexed core characteristics were extracted, complemented by a bibliometric and conceptual analysis. A total of 111 studies were included. Most studies were investigating interventions, followed by cognition and psychological processes, and neuroscientific topics. Their samples ranged from 15 to 91,199 (median 148) participants, with a mean age from 10 to more than 60 (median 33) years. There were several methodological inconsistencies relating to the definition of the gold standard (DSM/ICD diagnoses), of the outcome measures and of the transdiagnostic approach. The quality of the studies was generally low and only a few findings were externally replicated. The majority of studies tested transdiagnostic features cutting across different diagnoses, and only a few tested new classification systems beyond the existing diagnoses. About one fifth of the studies were not transdiagnostic at all, because they investigated symptoms and not disorders, a single disorder, or because there was no diagnostic information. The bibliometric analysis revealed that transdiagnostic research largely restricted its focus to anxiety and depressive disorders. The conceptual analysis showed that transdiagnostic research is grounded more on rediscoveries than on true innovations, and that it is affected by some conceptual biases. To date, transdiagnostic approaches have not delivered a credible paradigm shift that can impact classification and clinical care. Practical "TRANSD"iagnostic recommendations are proposed here to guide future research in this field.
当前基于国际疾病分类（ICD）/精神疾病诊断与统计手册（DSM）类别诊断的精神科分类方法的实用性仍值得怀疑。一种有前景的替代方法已被提出，即“跨诊断”方法。这种方法有望突破现有的类别诊断并超越它们，以改进我们对精神障碍的分类和治疗方式。本系统评价探讨了自我定义的跨诊断研究是否符合如此高的期望。根据预先制定的方案进行了多步骤的科学网文献检索，以识别截至2018年5月5日在标题中使用“跨诊断”一词的所有研究。提取了索引核心特征的实证变量，并辅以文献计量学和概念分析。共纳入111项研究。大多数研究调查的是干预措施，其次是认知和心理过程以及神经科学主题。其样本量从15名到91,199名参与者不等（中位数为148），平均年龄从10岁到60多岁（中位数为3）岁。在金标准（DSM/ICD诊断）的定义、结局指标和跨诊断方法方面存在一些方法学上的不一致。这些研究的质量普遍较低，只有少数研究结果得到了外部重复验证。大多数研究测试了跨越不同诊断的跨诊断特征，只有少数研究测试了现有诊断之外的新分类系统。约五分之一的研究根本不是跨诊断的，因为它们研究的是症状而非疾病、单一疾病，或者没有诊断信息。文献计量学分析表明，跨诊断研究在很大程度上局限于焦虑和抑郁障碍。概念分析表明，跨诊断研究更多地基于重新发现而非真正的创新，并且受到一些概念偏见的影响。迄今为止，跨诊断方法尚未带来能够影响分类和临床护理的可信范式转变。本文提出了实用 的“跨诊断”建议，以指导该领域的未来研究。
