Research domain criteria: a final paradigm for psychiatry?

Walter Glannon

doi:10.3389/fnhum.2015.00488

Abstract

Since the US Congress designated the 1990s as the “Decade of the Brain,” much of the research in psychiatry has endeavored to explain psychiatric disorders in terms of interconnected sets of dysfunctional neural circuits. The shift in focus from behavioral manifestations to the underlying neurobiology of mental illness has driven the field of biological psychiatry in general and the Research Domain Criteria (RDoC) in particular. The aim of the RDoC is to identify brain mechanisms that can explain the etiology and pathophysiology of psychiatric disorders, provide earlier and more accurate diagnosis, and predict treatment responses and outcomes (Insel et al., 2010; Casey et al., 2013). It incorporates genetics and behavioral science, including the influence of the environment on neurodevelopment, into a broad neuroscientific paradigm of psychiatry. By exploring the causes of mental illnesses and how these can inform interventions to modulate neural pathways, the circuit-based RDoC offers a more satisfactory account of these illnesses than the symptom-based Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In its current form, however, the RDoC may be too limited a theoretical model to provide a complete understanding of why mental illness develops, how it progresses, and how different treatments might control it. This raises the question of whether a more comprehensive version of the RDoC, or a different paradigm altogether, will be needed to guide research and clinical practice in psychiatry.

Highlights

Since the US Congress designated the 1990s as the “Decade of the Brain,” much of the research in psychiatry has endeavored to explain psychiatric disorders in terms of interconnected sets of dysfunctional neural circuits
Biomarkers may be mutations detected through genetic testing and screening, abnormal proteins discovered in bodily fluids, or structural and functional features of the brain displayed in neuroimaging (Boksa, 2013)
This study showed that a treatment-specific biomarker could guide treatment selection for patients with major depressive disorder (MDD)

Summary

Introduction

Since the US Congress designated the 1990s as the “Decade of the Brain,” much of the research in psychiatry has endeavored to explain psychiatric disorders in terms of interconnected sets of dysfunctional neural circuits. The notorious first era of psychosurgery developed and practiced by Moniz and Lima in the 1930s and 1940s and Freeman and Watts in the 1940s and 1950s was based on the idea that psychiatric disorders were caused by abnormalities in white-matter tracts in the prefrontal cortex and their projections to limbic structures (Pressman, 1998) Creating lesions in these tracts and severing connections in neural pathways to relieve symptoms was the ill-conceived rationale for Moniz and Lima’s prefrontal leucotomy and Freeman and Watts’ frontal lobotomy. Biomarkers may be mutations detected through genetic testing and screening, abnormal proteins discovered in bodily fluids, or structural and functional features of the brain displayed in neuroimaging (Boksa, 2013) Detecting these biological signatures might enable researchers and clinicians to identify those at risk of developing a disorder when they are in a pre-clinical state or have prodromal symptoms. By accounting for the variability of placebo responses among patients with depression, anxiety and other conditions, these mechanisms could improve therapy by inducing these responses as additive to the salutary effects of pharmacological agents

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Conclusion