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Speculations on the Future of Psychiatric Diagnosis

Rush, A., John, MD*†‡; Ibrahim, Hisham, M., MD§

The Journal of Nervous and Mental Disease: June 2018 - Volume 206 - Issue 6 - p 481–487
doi: 10.1097/NMD.0000000000000821
Clinical Controversies

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V), criterion symptom listings are frequently used in clinical practice as checklists to make diagnoses. However, most DSM-V conditions are, in fact, syndromes, that is, collections of signs and symptoms that commonly occur together in the clinic. This report discusses the value of syndromes in medicine and psychiatry. It is argued that a more precise future enumeration of brain circuits and the pathogenesis of psychiatric conditions will help us better understand and treat psychiatric syndromes, but they are unlikely to eliminate the need to categorize psychiatric conditions. We expect that biomarkers will play an increasingly critical role in psychiatric diagnosis. Beyond a better mechanistic understanding of the DSM-V syndromes, future diagnostic efforts will need to increase the focus on function and address risk factors for nonresponse and relapse. We suggest that new artificial intelligence advances will increase the efficiency and acceptability of psychiatric diagnosis and assist with treatment delivery.

*Duke-National University of Singapore, Singapore;

Department of Psychiatry, Duke University Medical School, Durham, NC;

Department of Psychiatry, Texas Tech Health Science Center, Permian Basin; and

§Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas.

Send reprint requests to Hicham Ibrahim, MD, Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9070. E-mail:

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