Changing the Diagnostic Concept of Schizophrenia: The NIMH Research Domain Criteria Initiative.

Abstract

Several factors have contributed to a renewed debate in recent years about the nature of schizophrenia. These include discussions about modifications to the diagnostic criteria for the DMS-5 and ICD-11 revisions, increasing data showing that schizophrenia and bipolar disorder do not “breed true,” GWAS findings of shared genetic risk among disorders, and endophenotype-based intermediate phenotypes that show considerable overlap across disorders. These factors accord with proposals that schizophrenia should be thought of not as a specific disease, but rather as a syndrome that represents one segment of a broad spectrum of serious mental illness. Testing such hypotheses requires a different approach to classification that transcends typical “disorder versus control” studies that preclude analysis of cross-cutting mechanisms. The NIMH Research Domain Criteria (RDoC) project was initiated to develop an experimental classification system based upon functional neurobehavioral domains that can be measured at various units of analysis. We provide an overview of the rationale and goals of the RDoC initiative and discuss examples from the recent schizophrenia literature that illustrate RDoC principles. These are intended to illustrate RDoC’s role in facilitating explorations of heterogeneity and co-morbidity that can lead to more precise diagnosis and treatment for psychotic disorders.