clinical stage and pathophysiological mechanisms to understand illness trajectories

Understanding illness trajectories in young people with psychotic syndromes

Despite the vast majority of major mental disorders having their onset in adolescence or early adulthood, current diagnostic frameworks often map poorly onto the early stages of illness.

Young people commonly experience less specific syndromes with mixed clusters of symptoms that do not clearly fit within specified categories and thresholds.

Further, diagnostic categories in these frameworks (based exclusively on sets of presenting symptoms) are assumed to represent independent clinical categories.

However, comorbidity is the rule rather than the exception in young people, and research regarding genetic, environmental and neurobiological risk factors does not readily support current assumptions regarding classification.

Considering the inadequacies of current diagnostic classification systems, an important clinical challenge is to derive new diagnostic frameworks.

These should be consistent with the current understanding of developmental epidemiology and neurobiology, reflect the experiences of individuals across the course of illness, and provide utility when used in a clinical setting for facilitating informed decisions regarding care and treatment.

In response to this challenge, we have developed a transdiagnostic framework incorporating two independent but complementary dimensions to classify common mood and psychotic syndromes in young people.

These two dimensions are clinical stage, reflecting the severity and persistence of illness, and pathophysiological mechanisms, reflecting the proposed underlying mechanisms of illness and their individual trajectories (or pathways).

To find out more, download our supplement ‘Combining clinical stage and pathophysiological mechanisms to understand illness trajectories in young people‘ from the peer-reviewed Medical Journal of Australia.