Psikiyatride Transdiagnostik (Tanı Ötesi) Yaklaşım Yerine Transsemptomatik (Semptom Ötesi) Tanı

Geleneksel olarak DSM ve ICD tanı sistemleri mental bozuklukları farklı etyolojileri ve klinik görünümleri sergileyen ayrı hastalıklar olduğu ilkesine dayanmaktadır. Buna karşın transdiagnostik yaklaşım genetik, epidemiyolojik ve sinirbilim araştırmalarında farklı psikiyatrik bozukluklar arasındaki büyük örtüşmelere işaret ederek anksiyete ve depresyon gibi birçok hastalığın ortak etyolojiyi paylaştığını ve benzer klinik özellikler taşıdığını savunur. Bu çerçevede bir araştırma modeli oluşturmak ve gelecekteki sınıflandırmaları şekillendirmek amacıyla Araştırma Alanı Kriterleri (Research Domain Criteria, RDoC) projesi başlatılmıştır. RDoC geleneksel tanı sınıflandırmalarından farklı olarak hastalıkları semptom kümeleri yerine patofizyoloji temelli, beynin nöronal devrelerinin işlev bozuklukları olarak değerlendirir. Ancak, transdiagnostik yaklaşım çalışmalarında karmaşık metodolojiler izlenmesi, kriterlerin net olmaması, çok farklı tanıların aynı çalışmaya dahil edilmesi ve ciddi psikiyatrik hastalıkların yeterince dahil edilmemesi şeklinde kısıtlılıklar bulunmaktadır. Bu yazıda “transdiagnositik (tanıl -ötesi) yaklaşım” yerine “transsemptomatik tanı (semptom ötesi tanı)” vurgulanarak psikiyatride doğru tanının önemi üzerinde durulmaktadır.

Anahtar Kelimeler:

Trandiagnostik yaklaşım, Araştırma Alanı Kriterleri, transsemptomatik tanı

Transsemptomatic Diagnosis as a Replacement for Transdiagnostic Approach in Psychiatry

Traditionally, the DSM and ICD diagnostic systems have been based on the principle that mental disorders are separate diseases with different etiologies and clinical manifestations. On the other hand, the transdiagnostic approach argues that many diseases such as anxiety and depression share a common etiology and have similar clinical features, pointing to the great overlap between different psychiatric disorders in genetic, epidemiological and neuroscience studies. In this context, the Research Domain Criteria (RDoC) project was initiated in order to create a research model and shape future classifications. Unlike traditional diagnostic classifications, RDoC assumes diseases as pathophysiology-based dysfunctions of the brain's neuronal circuits rather than symptom clusters. However, there are limitations in transdiagnostic approach studies such as complex methodologies, unclear criteria, inclusion of very different diagnoses in the same study, and insufficient inclusion of serious psychiatric diseases. In this article, the importance of correct diagnosis in psychiatry is stated by emphasizing “Trans-symptomatic diagnosis” instead of “Transdiagnostic approach”..

Keywords:

Transdiagnostic approach, Research Domain Criteria, transsymptomatic diagnosis,

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