Kas Martien J H, Hyman Steven, Williams Leanne M, Hidalgo-Mazzei Diego, Huys Quentin J M, Hotopf Matthew, Cuthbert Bruce, Lewis Cathryn M, De Picker Livia J, Lalousis Paris A, Etkin Amit, Modinos Gemma, Marston Hugh M
Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, the Netherlands.
Harvard University and Stanley Center, Broad Institute of MIT and Harvard, USA.
Eur Neuropsychopharmacol. 2025 Jan;90:16-27. doi: 10.1016/j.euroneuro.2024.08.515. Epub 2024 Sep 28.
Current nosology claims to separate mental disorders into distinct categories that do not overlap with each other. This nosological separation is not based on underlying pathophysiology but on convention-based clustering of qualitative symptoms of disorders which are typically measured subjectively. Yet, clinical heterogeneity and diagnostic overlap in disease symptoms and dimensions within and across different diagnostic categories of mental disorders is huge. While diagnostic categories provide the basis for general clinical management, they do not describe the underlying neurobiology that gives rise to individual symptomatic presentations. The ability to incorporate neurobiology into the diagnostic framework and to stratify patients accordingly will be a critical step forward for the development of new treatments for mental disorders. Furthermore, it will also allow physicians to provide patients with a better understanding of their illness's complexities and management. To realize this ambition, a paradigm shift is needed to build an understanding of how neuropsychiatric conditions can be defined more precisely using quantitative (multimodal) biological processes and markers and thus to significantly improve treatment success. The ECNP New Frontiers Meeting 2024 set out to develop a consensus roadmap for building a new diagnostic framework for mental disorders by discussing its rationale, outlook, and consequences with all stakeholders involved. This framework would instantiate a set of principles and procedures by which research could continuously improve precision diagnostics while moving away from traditional nosology. In this meeting report, the speakers' summaries from their presentations are combined to address three key elements for generating such a roadmap, namely, the application of innovative technologies, understanding the biology of mental illness, and translating biological understanding into new approaches. In general, the meeting indicated a crucial need for a biology-informed framework to establish more precise diagnosis and treatment for mental disorders to facilitate bringing the right treatment to the right patient at the right time.
当前的疾病分类学主张将精神障碍分为互不重叠的不同类别。这种疾病分类学上的划分并非基于潜在的病理生理学，而是基于对通常主观测量的疾病定性症状进行的基于惯例的聚类。然而，精神障碍不同诊断类别内部和之间的疾病症状及维度存在巨大的临床异质性和诊断重叠。虽然诊断类别为一般临床管理提供了基础，但它们并未描述导致个体症状表现的潜在神经生物学机制。将神经生物学纳入诊断框架并据此对患者进行分层的能力，将是精神障碍新疗法发展向前迈出的关键一步。此外，这也将使医生能够让患者更好地理解其疾病的复杂性及治疗方法。为实现这一目标，需要进行范式转变，以理解如何利用定量（多模态）生物学过程和标志物更精确地定义神经精神疾病，从而显著提高治疗成功率。欧洲神经精神药理学会2024年新前沿会议着手通过与所有相关利益者讨论其基本原理、前景和影响，制定一个构建精神障碍新诊断框架的共识路线图。该框架将确立一套原则和程序，通过这些原则和程序，研究可以在摆脱传统疾病分类学的同时不断提高精准诊断水平。在本会议报告中，将演讲者报告的摘要汇总起来，以阐述生成这样一个路线图的三个关键要素，即创新技术的应用、理解精神疾病的生物学机制以及将生物学理解转化为新方法。总体而言，会议表明迫切需要一个基于生物学的框架，以建立更精确的精神障碍诊断和治疗方法，以便在正确的时间为正确的患者提供正确的治疗。
