title: Psychiatric diagnosis revisited: towards a system of staging and profiling combining nomothetic and idiographic parameters of momentary mental states.
abstract: BACKGROUND
  Mental disorders may be reducible to sets of symptoms, connected through systems of causal relations. A clinical staging model predicts that in earlier stages of illness, symptom expression is both non-specific and diffuse. With illness progression, more specific syndromes emerge. This paper addressed the hypothesis that connection strength and connection variability between mental states differ in the hypothesized direction across different stages of psychopathology.
  
  
  METHODS
  In a general population sample of female siblings (mostly twins), the Experience Sampling Method was used to collect repeated measures of three momentary mental states (positive affect, negative affect and paranoia). Staging was operationalized across four levels of increasing severity of psychopathology, based on the total score of the Symptom Check List. Multilevel random regression was used to calculate inter- and intra-mental state connection strength and connection variability over time by modelling each momentary mental state at t as a function of the three momentary states at t-1, and by examining moderation by SCL-severity.
  
  
  RESULTS
  Mental states impacted dynamically on each other over time, in interaction with SCL-severity groups. Thus, SCL-90 severity groups were characterized by progressively greater inter- and intra-mental state connection strength, and greater inter- and intra-mental state connection variability.
  
  
  CONCLUSIONS
  Diagnosis in psychiatry can be described as stages of growing dynamic causal impact of mental states over time. This system achieves a mode of psychiatric diagnosis that combines nomothetic (group-based classification across stages) and idiographic (individual-specific psychopathological profiles) components of psychopathology at the level of momentary mental states impacting on each other over time.
authors.affiliation: Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands. hanneke.wigman@maastrichtuniversity.nl
authors.forename: Johanna T W
authors.initials: JT
authors.lastname: Wigman
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
authors.forename: Evert
authors.initials: E
authors.lastname: Thiery
authors.forename: Catherine
authors.initials: C
authors.lastname: Derom
authors.forename: Dina
authors.initials: D
authors.lastname: Collip
authors.forename: Nele
authors.initials: N
authors.lastname: Jacobs
authors.forename: Marieke
authors.initials: M
authors.lastname: Wichers
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis*; D008603:Mental Health; D008875:Middle Aged; D011599:Psychopathology; D012720:Severity of Illness Index; D055815:Young Adult
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