Trends in psychiatry and psychotherapy · 2024
A transdiagnostic model to prevention in mental and behavioral disorders: a comprehensive review and delineation of a new proposal.
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Cunha Graccielle, Zugman Andre, Pan Pedro, Fonseca Lais, Bressan Rodrigo, Paula Cristiane S, Sanchez Zila M, Mari Jair, Gadelha Ary
Аннотация
INTRODUCTION: Current disease-specific models for prevention of mental disorders are challenged by the overlap of psychopathology, biological mechanisms, and risk factors. Moreover, mental disorders usually begin during childhood or adolescence, when symptoms fluctuate and are highly non-specific.
DISCUSSION: We propose a staging model that integrates three domains - psychopathology, functional impairment and risk factors-, in which prevention is defined as actions to avoid stage progression, irrespective of diagnosis. Thus, preventive interventions should be broadened to include mental health promotion and strategies of risk reduction performed individually, at any stage, even for non-symptomatic subjects (before current at-risk definitions) currently exposed to risk factors.
CONCLUSIONS: The model features three innovations: a focus shift from disease conversion to stage progression, highlights functionality as an independent target, and acknowledgment of risk factors in the staging. The model must be validated before implementation.
DISCUSSION: We propose a staging model that integrates three domains - psychopathology, functional impairment and risk factors-, in which prevention is defined as actions to avoid stage progression, irrespective of diagnosis. Thus, preventive interventions should be broadened to include mental health promotion and strategies of risk reduction performed individually, at any stage, even for non-symptomatic subjects (before current at-risk definitions) currently exposed to risk factors.
CONCLUSIONS: The model features three innovations: a focus shift from disease conversion to stage progression, highlights functionality as an independent target, and acknowledgment of risk factors in the staging. The model must be validated before implementation.