Abstract
Several trends intersecting over the past two decades have generated increasing debate as to how the concepts of schizophrenia, the schizophrenia spectrum, and the psychotic disorders spectrum should be regarded. These trends are reflected in various areas of research such as genomics, neuroimaging, and data-driven computational studies of multiple response systems. Growing evidence suggests that schizophrenia represents a broad and heterogenous syndrome, rather than a specific disease entity, that is part of a multi-faceted psychosis spectrum. Progress in explicating these various developments has been hampered by the dependence upon sets of symptoms and signs for determining a diagnosis, and by the reliance on traditional diagnostic categories in reviewing clinical research grants. To address these concerns, the U.S. National Institute of Mental Health initiated the Research Domain Criteria (RDoC) project, a translational research program that calls for studies designed in terms of empirically-based functions (such as cognitive control or reward learning) rather than diagnostic groups. RDoC is a research framework rather than an alternative diagnostic system, intended to provide data that can inform future nosological manuals. This commentary includes a brief summary of RDoC as it pertains to schizophrenia and psychotic spectra, examples of recent data that highlight the utility of the approach, and conclusions regarding the implications for evolving conceptualizations of serious mental illness.
Highlights
The concept of schizophrenia (SZ) has elicited continual debate since the first descriptions of psychosis appeared in the middle of the nineteenth century
In September, 2020 the National Institutes of Health announced the AMP-SCZ initiative (Accelerating Medicines Partnership-Schizophrenia), bringing together NIH, the US Food and Drug Administration (FDA), and multiple non-profit and private organizations to seek biomarkers for the diverse array of clinical trajectories and adverse outcomes observed in individuals identified as at elevated risk of psychosis
While future directions remain difficult to predict given the nascent state of the research, novel research frameworks seem likely to foster the continued expansion of research designs and integrative science—and, in turn, to stimulate more precise thinking about the nosology of SZ and the psychosis spectrum
Summary
The concept of schizophrenia (SZ) has elicited continual debate since the first descriptions of psychosis appeared in the middle of the nineteenth century. RDoC and the Schizophrenia Spectrum hypotheses will embody DSM/ICD categories as their scientific focus, foiling applications proposing alternative approaches To address these problems, the US National Institute of Health (NIMH) initiated the Research Domain Criteria (RDoC) project in 2009 “to develop, for research purposes, new ways of [studying] mental disorders based on dimensions of observable behavior and neurobiological measures” [5]. RDoC was conceived as an experimental framework to support research in psychopathology organized around basic functional domains such as cognition, motivation, and motor activity, most of which are pertinent to multiple disorders as currently defined (and may partially account for the extensive co-morbidity in current disorders). Recent developments in the field demonstrate novel conceptions across the entire range of psychopathology, employing various types of dimensions, clusters, and hierarchical approaches that align with the RDoC approach [9]
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