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Robust empirical data and clinical utility: the only drivers of change: Commentary on… The Classification of Mental Disorder

  • Nick Craddock

Summary

We have arrived at our current descriptive classifications, with their many and varied array of categories, through the committee processes of DSM and ICD. To date, expert opinion, rather than solid science, has been the driver for change and this helps to explain the bewildering number of diagnostic categories and the fact that many patients meet criteria for several categories. Over the coming years, advances in neuroscience will offer the opportunity to base classification on robust evidence with diagnostic entities mapping more closely onto the workings of the brain. There are major shortcomings to the current classifications but all changes come at a cost to their users. We should be fully aware of the shortcomings and be thinking about the future. However, major changes to classification should await the emergence of robust empirical data and proven clinical utility. This will be the best way to benefit patients.

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Copyright

Corresponding author

Professor Nick Craddock, Department of Psychological Medicine and Neurology, Henry Wellcome Building, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, UK. Email: craddockn@cardiff.ac.uk

Footnotes

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See pp 2–9 and 14–19, this issue.

Declaration of Interest

None.

Footnotes

References

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Bullmore, E, Fletcher, P, Jones, PB (2009a) Why psychiatry can't afford to be neurophobic. British Journal of Psychiatry; 194: 293–5.
Bullmore, E, Sporns, O (2009b) Complex brain networks: graph theoretical analysis of structural and functional systems. Nature Reviews Neuroscience; 10: 186–98.
Craddock, N, Owen, MJ (2007) Rethinking psychosis: the disadvantages of a dichotomous classification now outweigh the advantages. World Psychiatry; 6 (2): 8491.
Craddock, N, O'Donovan, MC, Owen, MJ (2009) Psychosis genetics: modeling the relationship between schizophrenia, bipolar disorder, and mixed (or ‘schizoaffective’) psychoses. Schizophrenia Bulletin; 35: 482–90.
Craddock, N, Owen, MJ (2010) The Kraepelinian dichotomy: going, going, … but still not gone. British Journal of Psychiatry; in press.
Dikeos, DG, Wickham, H, McDonald, C et al (2006) Distribution of symptom dimensions across Kraepelinian divisions. British Journal of Psychiatry; 189: 346–53.
Goldberg, D (2010) The classification of mental disorder: a simpler system for DSM–V and ICD–11. Advances in Psychiatric Treatment; 16: 1419.
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Zielasek, J, Gaebel, W (2008) Modern modularity and the road towards a modular psychiatry. European Archives of Psychiatry and Clinical Neuroscience; 258 (suppl 5): 60–5.
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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
  • URL: /core/journals/bjpsych-advances
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Robust empirical data and clinical utility: the only drivers of change: Commentary on… The Classification of Mental Disorder

  • Nick Craddock
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