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Development of a Clinically Useful Classification of Mental Disorders for Global Primary Care

Concept Clearance

Presenter

Bruce Cuthbert, Ph.D.
Senior Adviser to the Director
National Institute of Mental Health

Goal

The goal of this initiative is to develop a clinically useful classification of mental disorders to identify people in need of mental health services in primary care settings, particularly in low- and middle-income countries.

Rationale

This initiative aims to consider whether correspondence can be created between a clinically useful classification of mental disorders for global primary care and the overarching typologies of mental disorders that have already been described and will continue to emerge from NIMH’s Research Domain Criteria (RDoC) project.

Based on clinical utility as an overarching priority, formative field studies will be designed to address three broad goals. Goal 1: How disorder categories should be organized by examining clinicians’ conceptualizations of mental disorders and their clinical management. Goal 2: Which clusters of disorders, conditions, or problems should be included in a diagnostic system to facilitate appropriate identification and treatment of mental and behavioral disorders at each level of care—mental health specialty or primary care.  Studies in primary care settings will focus on obtaining the best coverage of high-incidence and high-resource mental health problems, some of which may be most usefully described at the level of problems or symptom clusters rather than by formal diagnoses. Collaboration with NIMH would focus, in part, on relating this work to the domains emerging from the RDoC project.  Goal 3: How information for each disorder should be presented, especially to primary care health providers and patients, to maximize clinical utility.

Scientific Areas of Interest Include:

  • Developing ways to simplify, clarify, and reduce the number of mental disorder diagnoses essential for global primary care;
  • Focusing on the extent to which it is possible to develop a clinically useful classification of mental disorders for global primary care that is consistent with current knowledge regarding brain circuits germane to mental disorders, the focus of the RDoC project;
  • Examining primary care clinicians' conceptualizations of mental disorders and their clinical management.

Findings from this initiative may inform the diagnosis of mental disorders and interventions for them in clinical settings across the United States and its territories.