Evidence that We Should Be Less Pessimistic about the Transdiagnostic Dimension of Psychosis

Poster C57, Saturday, October 22, 11:30 am - 1:00 pm, Le Baron

Jim van Os1,2; 1Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands, 2King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom

New definitions of health are moving from ‘absence of disease and symptoms’ towards ‘the ability to display dynamic adaptation and self-management in the face of mental and physical challenges’. Thus, the ultimate goal of treatment is not symptom control, but rather a process where pursuit of individually meaningful goals, regardless of medical outcome, is the target. Research suggests that psychosis is a transdiagnostic dimension, the expression of which is governed by a dynamic set of contextual and emotional factors that are amenable to treatment. However, the dominant approach to date is to clinically and conceptually situate psychotic symptoms in the organic and poor outcome construct of schizophrenia. However, schizophrenia, which has a lifetime prevalence of 1%, only represents the poor outcome fraction of a much broader spectrum of psychotic disorders which have a lifetime prevalence of 3.5%. Therefore, research findings in schizophrenia may reflect mechanisms of prognosis rather than fundamental associations with psychosis and other symptom domains per se. Diagnostic manuals in psychiatry would benefit from a system of transdiagnostic dimensions, including a transdiagnostic dimension of psychosis. The advantage of such a system is that it encourages consideration of how symptoms dynamically interact with each other in a network of psychopathology, and of how this network is impacted by the social world. It encourages a novel way of thinking about treatment in terms of dynamic adaptation and pursuit of meaningful goals in the person’s environment, rather than symptom control as a goal per se.

Topic Area: Service System Development and Reform

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