title: [A fresh look at psychiatric disorders].
abstract: BACKGROUND
  The a-theoretical approach to psychiatric disorders, introduced via dsm iii, has had a tremendous impact. It has stimulated a large body of research, facilitated by the concurrent development of new techniques in genetics, neuro-imaging and neuropsychology. However, the research results of the last twenty years or so have cast doubt on the validity of the clinical categories set out in dsm iii.
  
  
  OBJECTIVE
  To develop a new view on developmental pathways in psychopathology, clinical assessment and scientifically acceptable classification.
  
  
  METHODS
  In this article we review the state of the art with regard to underlying endophenotypes at the level of brain and neurotransmitter functioning and neuropsychology and we consider the effect of social determinants on the developments of psychopathology.
  
  
  RESULTS
  Our results show that neither genotypes and endophenotypes, nor brain mechanism, nor neuropsychological deviances have a one-to-one correlation with clinical categories as defined in even the dsm 5.
  
  
  CONCLUSIONS
  dsm-5 provides a range of possibilities for classifying psychiatric disorders at symptom level. But these categories seem to be less distinct than was at first assumed. Recent research has shown that there is a great deal of overlap at the genetic, epigenetic and endophenotype level. This calls for more emphasis on individual assessment and diagnostics in both clinical practice and scientific research. More attention needs to be given to the dimensions of emotion and behavior, vulnerability and resilience. This type of approach, involving genotypes, endophenotypes, epigenetics and brain functioning, could help to elucidate the interaction between these various levels and/or explain the underlying mechanisms of psychiatric disorders.
authors.forename: P J M
authors.initials: PJ
authors.lastname: van Wijngaarden-Cremers
authors.forename: P
authors.initials: P
authors.lastname: van Deurzen
authors.forename: I
authors.initials: I
authors.lastname: Oosterling
authors.forename: W
authors.initials: W
authors.lastname: Groen
authors.forename: M
authors.initials: M
authors.lastname: Langen
authors.forename: A L
authors.initials: AL
authors.lastname: Lagro-Janssen
authors.forename: R J
authors.initials: RJ
authors.lastname: van der Gaag
mesh_terms: D057890:Epigenomics; D005838:Genotype; D006801:Humans; D001523:Mental Disorders / Q000145:classification* / Q000175:diagnosis*; D010555:Personality Inventory; D010641:Phenotype; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics