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Research Domain Criteria as Psychiatric Nosology

Conceptual, Practical and Neuroethical Implications

Published online by Cambridge University Press:  22 September 2017

FAISAL AKRAM  and
JAMES GIORDANO
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Abstract:

Diagnostic classification systems in psychiatry have continued to rely on clinical phenomenology, despite limitations inherent in that approach. In view of these limitations and recent progress in neuroscience, the National Institute of Mental Health (NIMH) has initiated the Research Domain Criteria (RDoC) project to develop a more neuroscientifically based system of characterizing and classifying psychiatric disorders. The RDoC initiative aims to transform psychiatry into an integrative science of psychopathology in which mental illnesses will be defined as involving putative dysfunctions in neural nodes and networks. However, conceptual, methodological, neuroethical, and social issues inherent in and/or derived from the use of RDoC need to be addressed before any attempt is made to implement their use in clinical psychiatry. This article describes current progress in RDoC; defines key technical, neuroethical, and social issues generated by RDoC adoption and use; and posits key questions that must be addressed and resolved if RDoC are to be employed for psychiatric diagnoses and therapeutics. Specifically, we posit that objectivization of complex mental phenomena may raise ethical questions about autonomy, the value of subjective experience, what constitutes normality, what constitutes a disorder, and what represents a treatment, enablement, and/or enhancement. Ethical issues may also arise from the (mis)use of biomarkers and phenotypes in predicting and treating mental disorders, and what such definitions, predictions, and interventions portend for concepts and views of sickness, criminality, professional competency, and social functioning. Given these issues, we offer that a preparatory neuroethical framework is required to define and guide the ways in which RDoC-oriented research can—and arguably should—be utilized in clinical psychiatry, and perhaps more broadly, in the social sphere.

Keywords

Research Domain Criteria (RDoC)psychiatryneuroscienceneuroethicsbiopsychosocial model
Type
Articles
Information
Cambridge Quarterly of Healthcare Ethics , Volume 26 , Special Issue 4: Clinical Neuroethics , October 2017 , pp. 592 - 601
Copyright
Copyright © Cambridge University Press 2017 

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References

Notes

1. Insel, TR. Translating scientific opportunity into public health impact: A strategic plan for research on mental illness. Archives of General Psychiatry 2009;66(2):128–33.CrossRefGoogle ScholarPubMed

2. Kozak, MJ, Cuthbert, BN. The NIMH research domain criteria initiative: Background, issues, and pragmatics. Psychophysiology 2016;53(3):286–97.CrossRefGoogle ScholarPubMed

3. Insel, TR, Landis, SC. Twenty-five years of progress: The view from NIMH and NINDS. Neuron 2013;80(3):561–7.CrossRefGoogle ScholarPubMed

4. See note 2, Kozak, Cuthbert 2016.

5. Spitzer, RL, Endicott, J, Robins, E. Research diagnostic criteria: Rationale and reliability. Archives of General Psychiatry 1978;35(6):773–82.CrossRefGoogle ScholarPubMed

6. Kapur, S, Phillips, AG, Insel, TR. Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Molecular Psychiatry 2012;17(12):1174–9.CrossRefGoogle Scholar

7. Hyman, SE. The diagnosis of mental disorders: the problem of reification. Annual Review of Clinical Psychology 2010;27(6):155–79.CrossRefGoogle Scholar

8. Cuthbert, BN. The RDoC framework: Facilitating transition from ICD/DSM to dimensional approaches that integrate neuroscience and psychopathology. World Psychiatry 2014;13(1):28–35.CrossRefGoogle ScholarPubMed

9. Engel, GL. The biopsychosocial model and the education of health professionals. General Hospital Psychiatry 1979;1(2):156–65.CrossRefGoogle ScholarPubMed

10. Wakefield, JC. The concept of mental disorder: on the boundary between biological facts and social values. American Psychologist 1992;47(3):373.CrossRefGoogle ScholarPubMed

11. Álvarez, AS, Pagani, M, Meucci, P. The clinical application of the biopsychosocial model in mental health: a research critique. American Journal of Physical Medicine & Rehabilitation 2012;91(13):S173–80.CrossRefGoogle ScholarPubMed

12. Meaney, MJ. Epigenetics and the biological definition of gene × environment interactions. Child Development 2010;81(1):41–79.CrossRefGoogle ScholarPubMed

13. See note 7, Hyman 2010.

14. Cuthbert, BN. Research domain criteria: Toward future psychiatric nosologies. Dialogues in Clinical Neuroscience 2015;17(1):89–97.Google ScholarPubMed

15. See note 12, Meaney 2010.

16. See note 14, Cuthbert 2015.

17. Weinberger, DR, Glick, ID, Klein, DF. Whither research domain criteria (RdoC)?: The good, the bad, and the ugly. JAMA Psychiatry 2015;72(12):1161–2.CrossRefGoogle ScholarPubMed

18. Patrick, CJ, Hajcak, G. RDoC: Translating promise into progress. Psychophysiology 2016;53(3):415–24.CrossRefGoogle ScholarPubMed

19. Cuthbert, BN, Insel, TR. Toward the future of psychiatric diagnosis: The seven pillars of RDoC. BMC Medicine 2013;11(1):1.CrossRefGoogle ScholarPubMed

20. Wakefield, JC. Wittgenstein’s nightmare: Why the RDoC grid needs a conceptual dimension. World Psychiatry 2014;13(1):38–40.CrossRefGoogle Scholar

21. Parnas, J. The RDoC program: psychiatry without psyche? World Psychiatry 2014;13(1):46–7.CrossRefGoogle ScholarPubMed

22. Peterson, BS. Editorial: Research domain criteria (RDoC): A new psychiatric nosology whose time has not yet come. Journal of Child Psychology and Psychiatry 2015;56(7):719–22.CrossRefGoogle Scholar

23. Maj, M. Keeping an open attitude towards the RDoC project. World Psychiatry 2014;13(1):1–3.CrossRefGoogle ScholarPubMed

24. Carroll, B. Clinical science and biomarkers: against RDoC. Acta Psychiatrica Scandinavica 2015;132(6):423–4.CrossRefGoogle ScholarPubMed

25. Nanaszko, M, Little, A. Two years since the BRAIN Initiative: Update on current scientific and technological neuroscience advancements. World Neurosurgery. 2015;84(5):1188–90.CrossRefGoogle ScholarPubMed

26. Park, H-J, Friston, K. Structural and functional brain networks: From connections to cognition. Science 2013;342(6158):1238411.CrossRefGoogle Scholar

27. See note 2, Kozak, Cuthbert 2016.

28. Dennett, DC. Heterophenomenology reconsidered. Phenomenology and the Cognitive Sciences 2007;6(1):247–70.CrossRefGoogle Scholar

29. See note 2, Kozak, Cuthbert 2016.

30. Levine, J. Materialism and qualia: The explanatory gap. Pacific Philosophical Quarterly 1983;64(4):354–61.CrossRefGoogle Scholar

31. Hershenberg, R, Goldfried, MR. Implications of RDoC for the research and practice of psychotherapy. Behavior Therapy 2015;46(2):156–65.CrossRefGoogle Scholar

32. Markowitz JC. There’s such a thing as too much neuroscience. The New York Times. Opinion Section, October 14, 2016; Available at http://www.nytimes.com/2016/10/15/opinion/theres-such-a-thing-as-too-much-neuroscience.html. (last accessed 20 Dec 2016).

33. See note 18, Patrick, Hajcak 2016.

34. See note 10, Wakefield 1992.

35. Shook, JR, Giordano, J. Neuroethics beyond normal: Performance enablement and self-transformative technologies. Cambridge Quarterly of Health Care Ethics 2016;25:121–40.CrossRefGoogle Scholar

36. Faucher, L, Goyer, S. RDoC: Thinking outside the DSM box without falling into a reductionist trap. In: The DSM-5 in Perspective. Dordrecht: Springer; 2015:199–224.Google Scholar

37. Paris, J, Kirmayer, LJ. The National Institute of Mental Health Research Domain Criteria: A bridge too far. The Journal of Nervous and Mental Disease 2016;204(1):26–32.CrossRefGoogle ScholarPubMed

38. Choudhury, S, Fishman, JR, McGowan, ML, Juengst, ET. Big data, open science and the brain: lessons learned from genomics. Frontiers in Human Neuroscience 2014;8:239.CrossRefGoogle ScholarPubMed

39. DiEuliis, D, Giordano, J. Neurotechnological convergence and “big data”: A force-multiplier toward advancing neuroscience. In: Collmann, J, Matei, SA, eds. Ethical Reasoning in Big Data: An Exploratory Analysis. NY: Springer; 2016:71–80.CrossRefGoogle Scholar

40. See note 21, Parnas 2014.

41. Torous, J, Stern, AP, Padmanabhan, JL, Keshavan, MS, Perez, DL. A proposed solution to integrating cognitive-affective neuroscience and neuropsychiatry in psychiatry residency training: the time is now. Asian Journal of Psychiatry 2015;17:116–21.CrossRefGoogle ScholarPubMed

42. Rüsch, N, Angermeyer, MC, Corrigan, PW. Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psychiatry 2005;20(8):529–39.CrossRefGoogle ScholarPubMed

43. Singh, I, Rose, N. Biomarkers in psychiatry. Nature 2009;460(7252):202–7.CrossRefGoogle Scholar

44. Giordano, J. The human prospect (s) of neuroscience and neurotechnology: Domains of influence and the necessity–and questions–of neuroethics. Human Prospect 2014;4(1):1–18.Google Scholar

45. Giordano, J, Benedikter, R. An early-and necessary-flight of the owl of Minerva: Neuroscience, neurotechnology, human socio-cultural boundaries, and the importance of neuroethics. Journal of Evolution and Technology 2012;22(1):14–25.Google Scholar

46. Herrera–Ferra, K, Giordano, J. Re-classifying recurrent violent behavior? Considerations, caveats and neuroethical concerns for psychiatry and social engagement. Acta Psychopathologica 2016;2(1):32–9.CrossRefGoogle Scholar

47. Giordano, J, Kulkarni, A, Farwell, J. Deliver us from evil? The temptation, realities, and neuroethico-legal issues of employing assessment neurotechnologies in public safety initiatives. Theoretical Medicine and Bioethics 2014;35(1):73–89.CrossRefGoogle ScholarPubMed

48. Shats, K, Brindley, T, Giordano, J. Don’t ask a neuroscientist about phases of the moon: Applying appropriate evidence law to the use of neuroscience in the courtroom. Cambridge Quarterly of Health Care Ethics. 2016;25:1–14.CrossRefGoogle Scholar

49. Giordano, J, Shook, JR. Minding brain science in medicine: On the need for neuroethical engagement for guidance of neuroscience in clinical contexts. Ethics in Biology, Engineering and Medicine. 2015;6(1–2):37–42.CrossRefGoogle Scholar

50. Shook, JR, Galvagni, L, Giordano, J. Cognitive enhancement kept within contexts: Neuroethics and informed public policy. Frontiers in Systems Neuroscience 2014;8:1–8.CrossRefGoogle ScholarPubMed

51. Giordano, J. A preparatory neuroethical approach to assessing developments in neurotechnology. AMA Journal of Ethics 2015;17(1):56–61.Google ScholarPubMed

52. Labrecque, LI, Markos, E, Milne, GR. Online personal branding: Processes, challenges, and implications. Journal of Interactive Marketing 2011;25(1):37–50.CrossRefGoogle Scholar

53. Kostiuk, SA. After GINA, NINA: Neuroscience-based discrimination in the workplace. Vanderbilt Law Review 2012;65:933.Google Scholar