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Dan Joseph Stein, STEVEN J. SHOPTAW, Daniel Vigo, Crick Lund, Pim J. Cuijpers, Jason R. Bantjes, Norman Sartorius, Mario Maj
Psychiatry has always been characterized by a range of different models of and approaches to mental disorder, which have sometimes brought progress in clinical practice, but have often also been accompanied by critique from within and without the field. Psychiatric nosology has been a particular focus of debate in recent decades; successive editions of the DSM and ICD have strongly influenced both psychiatric practice and research, but have also led to assertions that psychiatry is in crisis, and to advocacy for entirely new paradigms for diagnosis and assessment. When thinking about etiology, many researchers currently refer to a biopsychosocial model, but this approach has received significant critique, being considered by some observers overly eclectic and vague. Despite the development of a range of evidence-based pharmacotherapies and psychotherapies, current evidence points to both a treatment gap and a research-practice gap in mental health. In this paper, after considering current clinical practice, we discuss some proposed novel perspectives that have recently achieved particular prominence and may significantly impact psychiatric practice and research in the future: clinical neuroscience and personalized pharmacotherapy; novel statistical approaches to psychiatric nosology, assessment and research; deinstitutionalization and community mental health care; the scale-up of evidence-based psychotherapy; digital phenotyping and digital therapies; and global mental health and task-sharing approaches. We consider the extent to which proposed transitions from current practices to novel approaches reflect hype or hope. Our review indicates that each of the novel perspectives contributes important insights that allow hope for the future, but also that each provides only a partial view, and that any promise of a paradigm shift for the field is not well grounded. We conclude that there have been crucial advances in psychiatric diagnosis and treatment in recent decades; that, despite this important progress, there is considerable need for further improvements in assessment and intervention; and that such improvements will likely not be achieved by any specific paradigm shifts in psychiatric practice and research, but rather by incremental progress and iterative integration.
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Stein, D. J., SHOPTAW, S. J., Vigo, D., Lund, C., Cuijpers, P. J., Bantjes, J. R., Sartorius, N., & Maj, M. (2022). Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration. World Psychiatry, 21(3), 393–414. https://doi.org/10.1002/wps.20998
Stein, Dan Joseph, et al. "Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration." World Psychiatry, vol. 21, no. 3, 2022, pp. 393–414, https://doi.org/10.1002/wps.20998.
Stein, Dan Joseph, STEVEN J. SHOPTAW, Daniel Vigo, Crick Lund, Pim J. Cuijpers, Jason R. Bantjes, Norman Sartorius, and Mario Maj. "Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration." World Psychiatry 21, no. 3 (2022): 393–414. https://doi.org/10.1002/wps.20998.
Stein D. J., SHOPTAW S. J., Vigo D. [и др.] Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration // World Psychiatry. — 2022. — Vol. 21, № 3. — P. 393–414. — URL: https://doi.org/10.1002/wps.20998
@article{stein2022psychiatric,
title = {{Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration}},
author = {Dan Joseph Stein and STEVEN J. SHOPTAW and Daniel Vigo and Crick Lund and Pim J. Cuijpers and Jason R. Bantjes and Norman Sartorius and Mario Maj},
journal = {World Psychiatry},
year = {2022},
volume = {21},
number = {3},
pages = {393--414},
doi = {10.1002/wps.20998},
url = {https://doi.org/10.1002/wps.20998}
}TY - JOUR AU - Stein, Dan Joseph AU - SHOPTAW, STEVEN J. AU - Vigo, Daniel AU - Lund, Crick AU - Cuijpers, Pim J. AU - Bantjes, Jason R. AU - Sartorius, Norman AU - Maj, Mario TI - Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration JO - World Psychiatry VL - 21 IS - 3 SP - 393 EP - 414 PY - 2022 DA - 2022/09/08 DO - 10.1002/wps.20998 UR - https://doi.org/10.1002/wps.20998 ER -
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