Why the dsm 5-TR fails --

​Val's Take/Conjecture

​Metabolome subtyping reveals multi-omics characteristics and biological heterogeneity in major psychiatric disorders (2023)

*Chinese Researchers

​Abstract

Growing evidence suggests that major psychiatric disorders (MPDs) share common etiologies and pathological processes.

However, the diagnosis is currently based on descriptive symptoms, which ignores the underlying pathogenesis and hinders the development of clinical treatments.

​This highlights the urgency of characterizing molecular biomarkers and establishing objective diagnoses of MPDs.

​Here, we collected untargeted metabolomics, proteomics and DNA methylation data of 327 patients with MPDs, 131 individuals with genetic high risk and 146 healthy controls to explore the multi-omics characteristics of MPDs.

First, differential metabolites (DMs) were identified and we classified MPD patients into 3 subtypes based on DMs.

​The subtypes showed distinct metabolomics, proteomics and DNA methylation signatures.

Specifically, one subtype showed dysregulation of complement and coagulation proteins, while the DNA methylation showed abnormalities in chemical synapses and autophagy.

Integrative analysis in metabolic pathways identified the important roles of the citrate cycle, sphingolipid metabolism and amino acid metabolism.

​Finally, we constructed prediction models based on the metabolites and proteomics that successfully captured the risks of MPD patients.

Our study established molecular subtypes of MPDs and elucidated their biological heterogeneity through a multi-omics investigation.

These results facilitate the understanding of pathological mechanisms and promote the diagnosis and prevention of MPDs [Major Psychiatric Disorders].

Shared Genes & Psychiatric Disorders

​DSM-5-TR: overview of what’s new and what’s changed (2022)

​​"The American Psychiatric Association continues to welcome empirically-grounded proposals for change. Guidelines for submitting such proposals can be found at www.dsm5.org."

​If the APA is not embracing the "underlying biology" --- it is making an attempt to endorse "empiricism."

Further, there does seem to be a recognition that the DSM 5-TR is not the last word --- and that is a good thing. 

Additionally, the APA is working on DSM 6.

What is missing are the more fundamental criticisms of the DSM and a loss of "Faith" as a result of "Empiricism" in the category structure --- even with some updates.

​Precision Psychiatry Is the Future.  Europe Can Lead the Way (2023)

​"Today, the field is held back by a nosology that has good inter-rater reliability, but that has seen no validation of any diagnostic entity by specific biomarkers that would inform diagnosis, possibly irrespective of existing diagnostic entities.

"The lack of progress in the development of drugs is largely due to the fact that patients are seldom prescreened for specific biomarkers before being included in clinical trials.

"Neither are they commonly prescreened for the pathology, subgroup, and/or dimensions of interest to potentially respond to a specific drug.

"Both clinicians and regulatory agencies still work under the notion of “one size fits all,” which has induced errors and failures of clinical trials in past decades."

[This is ironic --- Rice University is in Texas]

​Towards a consensus roadmap for a new diagnostic framework for mental disorders (2024)

"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."