The relationist turn in understanding mental disorders

Question 1

categorical model=

Answer 1

a model that understands mental disorders implicitly as a group of symptoms that originate from a biological cause or derive from an essence of some sort. therefore: clusters of symptoms are independent from each other because they have a different cause (= essentialist thinking)

Question 2

critiques of the dsm

Answer 2

• based on a priori categories: lacks a solid empirical basis
• heterogeneity among patients with the same mental disorder, because of polythetic criteria sets
• arbitrary diagnostic thresholds

Question 3

essentialism =

Answer 3

Essentialism is the idea that people and things have ‘natural’ characteristics that are inherent and unchanging. Essentialism allows people to categorize, or put individual items or even people into groups, which is an important function of our brains.

Question 4

wat missen we door die essentialism?

Answer 4

a mere symptom definition may be too superficial and narrow to represent mental disorders, or grasp a concept as complicated as mental health. we miss the possibility that symptoms could cause each other instead of being caused by an underlying entity. too simple?

Question 5

having one model is problematic:

Answer 5

the categorical model dsm tries to serve various needs simultaneously, such as administration, policy making, treatment and research -> one size fits all, but different purposes require different levels of simplification and precision, as well as descriptions at either the population or individual level.

Question 6

volgorde van hitop

Answer 6

superspectra = higher order dimensions
spectra = somatoform, internalising, thought disorder, disinhibited externalising, antagonistic externalising, detachment
subfactors = sexual/eating/fear/distress/mania/substance abuse/antisocial behaviour
syndromes/disorders
symptoms/components = symptoms components and maladaptive traits + signs and symptoms

Question 7

wat is een nadeel aan hitop

Answer 7

• niet heel bruikbaar in de praktijk en in research: complex for administration and communication
• these models rely on factor analysis to identify clusters of symptoms, but still fail to prove the existence of underlying markers or factors
• this bottom-up approach still seams to be influenced by a top-down interpretation (therefore still essentialism)

Question 8

voordeel aan hitop

Answer 8

enables practitioners to treat common characteristics across multiple conditions

Question 9

network theory=

Answer 9

a paradigm shift. views mental disorders as:
1. complex systems with multifactorial constitution, rejecting the noition of central disease mechanisms
2. symptoms are constitutive of mental disorders instead of reflective of it (network structure)
3. comorbidity is inherent, with symptoms acting as bridges between different syndromes
4. the concept of hysteresis suggests that networks can become self-sustaining, even after the stressor is gone
5. symptom-component correspondence: aligns network structures of symptoms with the categories of diagnostic manuals

Question 10

wat is lastig aan network theory

Answer 10

while embracing nonlinear complexity, it still relies on the dsm components, potentially reintroducing reductionism and essentialism. the demarcation of what to include in the network is based on the dsm, because we dont know the mechanisms driving the mental disorders. we should also incorporate external influences and symptom transcending factors.

Question 11

transdiagnostic approach =

Answer 11

originates from patient contact, aims to understand the problems of human living beyond dsm categories. focuses on broad categories and dimensions (rather than diagnoses). could potentially serve research and practical purposes

bv clinical perfectionism, mood intolerance, emotional awareness, self-esteem, emotional regulation, negative affectivity

Question 12

wat is lastig aan transdiagnostic model

Answer 12

• de definitie van transdiagnostic: lack of clarity on what constitutes a diagnosis.
• there is also no clear model yet
• lumping: het gooit vanalles bij elkaar
• not clear how this can personalize treatment

Question 13

precision psychiatry =

Answer 13

high level of exactness in measurements, convergence of genetics, neuroscience etc.

however, translation of biological associations into clinical practice is uncertain, and there are important socio & psycho markers that are not included here.

also concerns regarding the organization of healthcare cosists, an personal contact diminishing due to these methods

Question 14

nadelen personalized psychiatry

Answer 14

• how much complexity will this model allow?
• high need for long-term engagement

Question 15

hoe laten we personalized approach zien

Answer 15

n = 1

(each individual is unique)

Question 16

what allows for repeated assessments of individuals in real time

Answer 16

experience sampling method

Question 17

wat is het voordeel aan experience sampling method

Answer 17

shifts the focus from syndromal to symptom-based diagnosis, from group to individual and from static to dynamic understanding

Question 18

lastig aan experience sampling method

Answer 18

blijven de patients wel engaged?

Question 19

dus pros van personalized psychiatry (n=1)

Answer 19

• real life observations
• insight in relationships between issues
• shift from syndromes to symptom focus

Question 20

person-centred approach

Answer 20

focus on values, resilience, and other aspects of positive health, promoting shared decision making and prioritizing patients needs. it co-constructs personalized narratives of illness and positive health between clinicians and patients (hope, identity, finding meaning, empowerment)

Question 21

wat is een nadeel aan person centered approach

Answer 21

het past niet echt binnen ons huidige systeem

Question 22

wat is een verschil tussen diagnose en dsm diagnose

Answer 22

diagnosis= implies thorough understanding of an individuals mental problem
dsm diagnosis = solely based on symptom clusters

Question 23

wat laat die confused concepts zien

Answer 23

dat we echt goed moeten blijven differentieren tussen individual-level clinical care and group-level research. therefore we should use dsm-classifications (instead of dsm diagnosis)

Question 24

what are the three main proposals for taxonomy

Answer 24

• hitop
• transdiagnostic approach
• person-centred approach

Question 25

wat zei Frankl

Answer 25

importance of meaning making, mental suffering often stems from struggles with finding purpose.

logotherapy: focuses on shifting individual meanings within patients

Question 26

samenvatting van het artikel

Answer 26

• explores the need for a shift in understanding and treatment of mental disorders -> relationality perspective
• critiques the reductionist and essentialist approach of current categorical models
• replacing the language of diagnoses to classifications
• advocates for taxonomies that reflect observable phenomena
• adopting an empirical dimensional, bottom-up taxonomy to better facilitate research and clinical decision making
• advocates for a highly personalized, symptom transcending, dynamic model that considers the whole person.
• potential of AI to assist with personalized diagnostics and therapy.
• emphasizes the understanding of mental disorders in relation to social/psychological/existential markers.
• importance of therapeutic relationship
• treatments based on relationalist model may be more accurate, precise, and personalized learning to improved outcomes and reduced healthcare costs over time