Adelphi Nurse Practitioners' Role in Predictive Personalized Preemptive and Participatory Medicine

Adelphi University

Question Description

post a comprehensive response to the following, please support your point with case studies, and articles:

- Pathophysiology covers all aspects of a disease, and is key for diagnosis and treatment planning. There is a new concept called the 4 P’s of Medicine," and it focuses on Predictive, Personalized, Preemptive, and Participatory medicine. Prediction focuses on how, when, and in whom a disease will develop and is directly related to pathophysiology.

- Please discuss nurse practitioners' role in "Predictive, Personalized, Preemptive, and Participatory Medicine" concept which is a very important topic for nurse practitioners' future status.

Unformatted Attachment Preview

STRESS, 2017 VOL. 20, NO. 1, 95–111 ORIGINAL RESEARCH REPORT The DSM5/RDoC debate on the future of mental health research: implication for studies on human stress and presentation of the signature bank S. J. Lupiena,b,c, M. Sassevilleb,c, N. Françoisb, C. E. Giguereb, J. Boissonneaultb, P. Plusquellecb,d, R. Godboutb,c, L. Xiongb,c, S. Potvinb,c, E. Kouassib, A. Lesageb,c and the Signature Consortiumb a Centre for Studies on Human Stress, CIUSSS Est, Quebec, Canada; bResearch Centre, Montreal Mental Health University Institute, CIUSSS Est, Quebec, Canada; cDepartment of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, Canada; dDepartment of Psychoeducation, Faculty of Arts and Sciences, University of Montreal, Montreal, Canada ABSTRACT ARTICLE HISTORY In 2008, the National Institute of Mental Health (NIMH) announced that in the next few decades, it will be essential to study the various biological, psychological and social “signatures” of mental disorders. Along with this new “signature” approach to mental health disorders, modifications of DSM were introduced. One major modification consisted of incorporating a dimensional approach to mental disorders, which involved analyzing, using a transnosological approach, various factors that are commonly observed across different types of mental disorders. Although this new methodology led to interesting discussions of the DSM5 working groups, it has not been incorporated in the last version of the DSM5. Consequently, the NIMH launched the “Research Domain Criteria” (RDoC) framework in order to provide new ways of classifying mental illnesses based on dimensions of observable behavioral and neurobiological measures. The NIMH emphasizes that it is important to consider the benefits of dimensional measures from the perspective of psychopathology and environmental influences, and it is also important to build these dimensions on neurobiological data. The goal of this paper is to present the perspectives of DSM5 and RDoC to the science of mental health disorders and the impact of this debate on the future of human stress research. The second goal is to present the “Signature Bank” developed by the Institut Universitaire en Sante Mentale de Montr eal (IUSMM) that has been developed in line with a dimensional and transnosological approach to mental illness. Received 9 August 2016 Revised 9 November 2016 Accepted 18 December 2016 Mental health research in the twenty-first century The period from 1990 to 2000 has been termed the decade of the brain (Health, 2015), leading to major discoveries in the field of genetics, neuroimaging and degenerative disorders (Cuthbert & Insel, 2010, 2013). Based on these significant discoveries, the National Institute of Mental Health (NIMH) in the United States announced in its 2008 strategic plan (Health, 2008) that the next decade would be devoted to applying the acquired knowledge to patient populations suffering from mental health disorders. In other words, it would be committed to making this period the “decade of the patient”. According to the NIMH, mental health research must correspond to the four Ps of personalized medicine – Predictive, Preemptive, Personalized and Participatory – in order to be innovative. To accomplish this, it will be essential to study the various biological, psychological and social “signatures” of mental disorders as well as the interactions between different biological signatures, clinical manifestations and psychosocial determinants of mental health across the lifespan and as a function of exposure to different environments. The “signatures” of mental illness is a term formulated by the NIMH CONTACT Sonia J. Lupien Montreal H1N 3M5, Canada KEYWORDS Mental health; DSM5; RDoC; biological signature; dimensions; developmental psychopathology; development; environment to designate the broad range of biological, psychological and social factors that may “sign” a specific mental health disorder, depending on an individual’s sex, history, lifestyle habits and so on (Health, 2008, 2015). Personalized mental health medicine represents an approach specifically adapted to the challenges of twentyfirst century health, especially with regard to chronic illnesses. Chronic illnesses are now recognized as being the leading causes of morbidity and mortality in contemporary societies, as well as the main drivers of health service utilization and associated expenses. In the health care system, mental health disorders are among the most common and costly chronic illnesses (Reeves et al., 2011). In 2004, an estimated 25% of adults in the United States reported having a mental illness in the previous year (Reeves et al., 2011), and this led to a total cost of $300 billion in 2002. Despite this, mental illnesses do not always receive the attention they deserve, and those affected by mental illness do not receive all the treatment they need, since current research is still being conducted in a non-concerted manner, with researchers separately seeking to identify the gene, the biomarker or the Centre for Studies on Human Stress, Montreal Mental Health University Institute, 7331 Hochelaga, ß 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. 96 S. J. LUPIEN ET AL. psychological factor that predicts a mental illness categorized as a function of symptoms rather than validated medical tests. At the present time, there is significant growth in the area of developing genetic biobanks that enable long-term storage of DNA samples with the goal of later studying various diseases such as cancer and cardiovascular disorders. However, the studies conducted to date on the genetic causes of mental disorders have had little success, and the NIMH suggested that this failure may be due to the fact that researchers are still looking for a single signature of mental illness when they should instead be seeking multiple signatures (Health, 2008). The fact is, to understand complex chronic illnesses such as mental diseases, it is necessary to be innovative and move away from a reductionist approach that basically involves identifying one gene or one brain abnormality as the factor explaining a mental disorder. One of the main reasons that have been given to explain the failure of biological mental health studies is the absence of a good phenotypic classification (Cuthbert & Insel, 2010, 2013; Kapur et al., 2012). Here, it has been suggested that neurobiological studies have been unable to find any genetic or neuroscientific evidence or a single “biological signature” of the different categories of mental illnesses proposed by DSM over its various versions (Cuthbert & Insel, 2013; Doherty & Owen, 2014; Insel et al., 2010), because the phenotype used in these studies, i.e. the diagnostic criteria as determined by DSM categories, is not the best phenotype to use in order to determine the biological signature of mental illness (Casey et al., 2013; Cuthbert & Insel, 2010; Insel et al., 2010). The categorical approach to mental health disorders Long before the first edition of the DSM was published in 1952, it was recognized that there was a need to distinguish between diseases – i.e. to differentiate between various pathologies when choosing a treatment. Indeed, the more clearly various problems were distinguished, the greater the likelihood of successful medical treatment. It was Emil Kraepelin who developed the first classification system resembling what is now found in the DSM. His Lehrbuch der Psychiatrie categorized mental disorders based on their nature, and he developed hypotheses about their causes, evolution and prognoses (see Kohl, 1999a,b). Since DSM-I was published, many revisions have been made in order to provide caregivers and researchers with the most up-to-date data. However, across all of the versions of DSM, there is one common assumption, i.e. such a categorical approach to mental illnesses assumes that mental disorders are discrete entities shared by relatively homogeneous populations that will display similar symptoms of any given disorder. Based on this definition, a categorical diagnosis can thus only have two values, i.e. presence or absence of a given disorder. Over the years, there have been various discussions about the validity of the way these diagnostic categories are constructed. Three main critics of the categorical approach to psychiatry have been raised in the scientific literature over the years. First, it has been stated that the first assumption of the categorical approach (i.e. “mental disorders are discrete entities shared by homogeneous populations”) is not valid. Indeed, it is well known that psychiatric populations are highly heterogeneous and it is highly common to see patients showing more than one clear psychiatric diagnosis (Regier, 2008; Widiger & Coker, 2003). This heterogeneity led, over the years, to the diagnostic category of “Not otherwise specific” (NOS; First, 2010). The NOS category is often referred to as the “catch-all” category (Millon, 1991). It is generally used when a clinician determines that a mental illness is present, although the patient fails to meet the criteria for one of the existing diagnostic category. Although this category should be given rarely, studies show that the NOS category is used as often as any of the specific diagnostic categories of the DSM (Cassano et al., 1999; Fairburn et al., 2007; Wilberg et al., 2008). Second, although a categorical diagnostic approach considers that patients suffering for a given mental illness display similar symptoms, we now know that there is a lot of overlap of symptoms in psychiatric populations, and this explains the high level of comorbidities observed in patients. “Pure” psychiatric syndromes are extremely rare in psychiatric research, and it is very common to see patients receiving two, three and even four types of psychiatric diagnoses (Andrews et al., 2002; Kessler et al., 1996; Mineka et al., 1998). For example, an Australian study of 10,000 participants reported that 40% of the sample met the diagnostic criteria for more than one current mental health disorder (Andrews et al., 2002). Moreover, mood disorders show high comorbidity with anxiety disorders (Kessler et al., 1996; Mineka et al., 1998), and mood and anxiety disorders are comorbid with substance use disorders, personality disorders and eating disorders (Mineka et al., 1998; Widiger & Clark, 2000). This suggests that there might be a problem with the “phenotype” of mental illness, i.e. an organism's observable characteristics or traits related to a particular mental disorder (Kupfer, 2005). Third, studies on childhood and adolescence often report that psychiatric categories, as defined by the DSM, are unable to capture a common source of variation in developmental psychopathology: the stage of development (see Beauchaine & McNulty, 2013). Indeed, more and more studies report that the psychiatric diagnostic category seems to change with a child or teenager’s development (Cuthbert & Kozak, 2013). Clinicians and scientists have also criticized the fact that certain criteria do not sufficiently account for the full complexity of the psychopathological phenomena experienced by children and adolescents suffering from various forms of psychopathologies (Haggerty et al., 1996; Rutter, 2003; Rutter et al., 2003; Rutter & Sroufe, 2000). Consequently, the principle of categorization limits the ability to capture nuances that could be used to indicate the intensity of various symptoms or their evolution over time. A new dimensional approach to mental disorders Despite the millions of research dollars that were spent on trying to find the “biomarker” of a specific mental health disorder as defined by the DSM, not a single study led to the discovery of a biological test with a clinical utility to diagnose a given mental illness. Consequently, various scientists started to question the reason for this failure. STRESS In an important paper published in 2012, Kapur et al. (2012) suggested that four main factors can explain this failure. First, compared to other medical fields that have biological tests to diagnose disorders, the field of psychiatry did not find any biological marker that can differentiate between patients and control and/or between patients. Second, although there has been a very large number of studies published on neurobiological dysfunctions in various mental disorders, most of these studies have small or moderate effect sizes, even though group differences are significant at p < .05. This led to a tremendous number of scientific papers published on various “biomarkers” of mental disorders, but no single consensus on a single clinical test that could be efficient at distinguishing a given mental illness. Third, replication studies are extremely rare in psychiatry and the majority of studies that try to replicate a given finding include small variations in patient populations, measures and/or biological measures, which lead to “approximate replications”. When this happens, any difference between two studies is explained by differences in patients populations, measures or biological tests, and this prevents the development of significant biological tests for a given mental illness. Finally, most studies in psychiatric research compare prototypical patients and “picture-perfect” healthy controls, which leads to significant results that may be difficult to replicate when one tries to distinguish between different patient types. Based on Kapur and colleagues review (Kapur et al., 2012), all of these factors led to a Catch-22 where the current diagnostic system was not designed to facilitate biological differentiation, and the biological studies have not been able to propose a clinically viable alternative system. Based on this analysis, they suggested that in order to provide clinical tests of psychiatric disorders, the field of biological psychiatry will have to change its mindset. Rather than having a strict allegiance on DSM or ICD diagnostic categories, the field should collect data across the current diagnostic categories, focus on comparing across disorders as much as comparing patients to control subjects, and should collect longitudinal data so that we can move toward the development of biological clinical tests for mental illness (Kapur et al., 2012). The DSM-5 dimensional approach The first attempt to develop such a transnosological approach was made by various committees working on the fifth version of the DSM. In 2000, over 500 world-renowned researchers and clinicians were invited to be involved in the DSM revision process. In addition to the general revision of diagnostic criteria for each disorder and a somewhat different approach to organizing disorders, modifications were being proposed that would affect most, if not all, mental disorders in the DSM. One of the major modifications in the DSM-5 consisted of incorporating a dimensional approach to mental disorders, which would involve analyzing various dimensions or functions that are associated with many different types of mental disorders. For example, anxious symptoms occur in conjunction with many mental disorders, and consequently, the presence 97 of anxiety in a given patient may therefore be enough to “sign” a mental disorder and cut across various diagnoses. Consequently, the nature of the anxiety could indicate an individual’s underlying vulnerability to specific disorders. The DSM would continue to propose diagnostic categories of mental disorders, but would include this new, dimensional approach. Various working groups were developed between 2000 and 2012 to work on the revision of the DSM and in July 2006, a diagnosis-related research planning conference focusing on dimensional approaches in diagnostic classification was held at the Natcher Conference Center on the NIH campus in Bethesda, Maryland. Twenty-eight invited scientists from around the world participated and worked at delineating the advantages of adding a dimensional approach to the DSM5 (,2006).aspx). Five general advantages of adding a dimensional approach to DSM-5 were described by this committee. Greater precision First, the decision to make use of dimensions in combination with categories was related to the quality of the diagnosis being made rather than the nature of the disorder being diagnosed. For instance, while a dimensional assessment would make it possible to evaluate on a scale with at least three points (e.g. no disorder versus mild disorder versus severe disorder), categorical assessment is by definition limited to two points (e.g. present versus not present). At the level of clinical practice, this restricts the extent to which it is possible to provide a detailed diagnosis. Either the disorder is present or it is not; there are no nuances. At the level of research, being able to use dimensional assessments as well as categorical measures could make it possible to study the potential modulating effect of certain aspects of mental disorders (e.g. anxious symptoms) on the severity of a given mental disorder. Scientists and clinicians participating in this event suggested that introducing the use of dimensional measures should be entirely feasible given the current state of clinical practice and scientific research. First, dimensional tools (e.g. questionnaires) are already widely used in different fields (e.g. somatic and cognitive symptoms of anxiety, panic, avoidance), and the dimensional approach is already standard in research (e.g. asking about the number of panic attacks). Additionally, there was the possibility of drawing on work being done on other subjects in medicine (e.g. hypertension, obesity). In short, the beneficial effects on clinical practice and research offered by the increased precision and more complex nuances of dimensional measures were clear to the research field. They enhanced the ability to determine the effect of a treatment, enabled greater precision in quantifying that effect, improved the capacity to detect existing signals and made it possible to identify more treatment possibilities. More faithful to reality Dimensional measures would make it possible to establish an individual’s risk of a given disease with a greater degree of 98 S. J. LUPIEN ET AL. nuance. An example of this is the “metabolic syndrome,” that is associated with a high risk of cardiovascular disease (CVD). Originally, a person with three of the five risk factors for CVD is deemed to have a metabolic syndrome and be at high risk of CVD. But with two risk factors out of five, an individual is still at risk of CVD; the risk is only slightly reduced. Adopting an approach based on “degree of risk” (dimensional approach) rather than on “at risk” versus “not at risk” dichotomy (categorical approach) therefore would seem appropriate. This approach better represents the reality and makes it possible to intervene in an incremental manner with less severe cases before they become more serious. This also offers a way to resolve the problem of categorical thresholds, given that individuals in a subclinical state may also be negatively impacted by their condition and could benefit from treatment. This kind of dimensional approach wo ...
Purchase answer to see full attachment

Final Answer

Hello. Please find the attached file below and please feel free to ask me incase of any questions. Otherwise, kindly invite me for more questions

Running Head: 4Ps of Medicine


Your name
Instructor name
Submission date

Running Head: 4Ps of Medicine

4Ps of Medicine

The biology system will help in revolutionizing healthcare practices in the years to come.
Medicine is reactive in nature as it waits until a sick for them to be treated. This results in
varying its success levels (Sanchez & Gray, 2014). The medicine will now undergo a series of
revolution so as to transform the healthcare role from being a reactive center to ...

University of Virginia

Solid work, thanks.

The tutor was great. I’m satisfied with the service.

Goes above and beyond expectations !

Similar Questions
Related Tags

Brown University

1271 Tutors

California Institute of Technology

2131 Tutors

Carnegie Mellon University

982 Tutors

Columbia University

1256 Tutors

Dartmouth University

2113 Tutors

Emory University

2279 Tutors

Harvard University

599 Tutors

Massachusetts Institute of Technology

2319 Tutors

New York University

1645 Tutors

Notre Dam University

1911 Tutors

Oklahoma University

2122 Tutors

Pennsylvania State University

932 Tutors

Princeton University

1211 Tutors

Stanford University

983 Tutors

University of California

1282 Tutors

Oxford University

123 Tutors

Yale University

2325 Tutors