Towards a consensus roadmap for a new diagnostic framework for mental disorders.

Current nosology claims to separate mental disorders into distinct categories that do not overlap with each other. This nosological separation is not based on underlying pathophysiology but on convention-based clustering of qualitative symptoms of disorders which are typically measured subjectively. Yet, clinical heterogeneity and diagnostic overlap in disease symptoms and dimensions within and across different diagnostic categories of mental disorders is huge. While diagnostic categories provide the basis for general clinical management, they do not describe the underlying neurobiology that gives rise to individual symptomatic presentations. The ability to incorporate neurobiology into the diagnostic framework and to stratify patients accordingly will be a critical step forward for the development of new treatments for mental disorders. Furthermore, it will also allow physicians to provide patients with a better understanding of their illness's complexities and management. To realize this ambition, a paradigm shift is needed to build an understanding of how neuropsychiatric conditions can be defined more precisely using quantitative (multimodal) biological processes and markers and thus to significantly improve treatment success. The ECNP New Frontiers Meeting 2024 set out to develop a consensus roadmap for building a new diagnostic framework for mental disorders by discussing its rationale, outlook, and consequences with all stakeholders involved. This framework would instantiate a set of principles and procedures by which research could continuously improve precision diagnostics while moving away from traditional nosology. In this meeting report, the speakers' summaries from their presentations are combined to address three key elements for generating such a roadmap, namely, the application of innovative technologies, understanding the biology of mental illness, and translating biological understanding into new approaches. In general, the meeting indicated a crucial need for a biology-informed framework to establish more precise diagnosis and treatment for mental disorders to facilitate bringing the right treatment to the right patient at the right time.
Competing Interests: Declaration of competing interest MJHK, DHM, MH, and BC declare no conflict of interest. SH is member of the scientific advisory boards for Johnson and Johnson (formerly Janssen) and F-Prime Capital, and he is member of the Boards of Directors for Voyager Therapeutics, Cyclerion Therapeutics, and Vesalius Therapeutics. LMW discloses the following patents in which she contributed, namely, US Patent App. 16/921,388, 16/368,774, 10,702,232 B2, 15/997,631, 10,285,658, 15/830,338, 10,034,645. LJdP declared consultancy and paid presentations for Boeringer-Ingelheim, paid presentation for Viatris – all outside the current work. LJdP is also the Co-chair of the ECNP Immuno-NeuroPsychiatry Network. CML is SAB for Myriad Neuroscience. Speaker & Consultancy fees from UCB and SYNLAB. AE receives salary and equity from Alto Neuroscience, and equity from Akili Interactive. PAL has received honoraria for talks presented at educational meetings organised by Boehringer-Ingelheim outside of the presented work. QJMH has obtained fees and options for consultancies for Aya Technologies and Alto Neuroscience. HM is a full-time employee of Boehringer Ingelheim Pharma GmbH.
(Copyright © 2024. Published by Elsevier B.V.)