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    Transdiagnostic clinical staging in youth mental health: a first international consensus statement

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    Author
    Shah, JL; Scott, J; McGorry, PD; Cross, SPM; Keshavan, MS; Nelson, B; Wood, SJ; Marwaha, S; Yung, AR; Scott, EM; ...
    Date
    2020-06-01
    Source Title
    World Psychiatry
    Publisher
    WILEY
    University of Melbourne Author/s
    McGorry, Patrick; Nelson, Christopher; Yung, Alison; Conus, Philippe; Wood, Stephen
    Affiliation
    Centre for Youth Mental Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Shah, J. L., Scott, J., McGorry, P. D., Cross, S. P. M., Keshavan, M. S., Nelson, B., Wood, S. J., Marwaha, S., Yung, A. R., Scott, E. M., Ongur, D., Conus, P., Henry, C. & Hickie, I. B. (2020). Transdiagnostic clinical staging in youth mental health: a first international consensus statement. WORLD PSYCHIATRY, 19 (2), pp.233-242. https://doi.org/10.1002/wps.20745.
    Access Status
    Access this item via the Open Access location
    URI
    http://hdl.handle.net/11343/254199
    DOI
    10.1002/wps.20745
    Open Access URL
    http://doi.org/10.1002/wps.20745
    Abstract
    Recognizing that current frameworks for classification and treatment in psychiatry are inadequate, particularly for use in young people and early intervention services, transdiagnostic clinical staging models have gained prominence. These models aim to identify where individuals lie along a continuum of illness, to improve treatment selection and to better understand patterns of illness continuity, discontinuity and aetiopathogenesis. All of these factors are particularly relevant to help-seeking and mental health needs experienced during the peak age range of onset, namely the adolescent and young adult developmental periods (i.e., ages 12-25 years). To date, progressive stages in transdiagnostic models have typically been defined by traditional symptom sets that distinguish "sub-threshold" from "threshold-level" disorders, even though both require clinical assessment and potential interventions. Here, we argue that staging models must go beyond illness progression to capture additional dimensions of illness extension as evidenced by emergence of mental or physical comorbidity/complexity or a marked change in a linked biological construct. To develop further consensus in this nascent field, we articulate principles and assumptions underpinning transdiagnostic clinical staging in youth mental health, how these models can be operationalized, and the implications of these arguments for research and development of new service systems. We then propose an agenda for the coming decade, including knowledge gaps, the need for multi-stakeholder input, and a collaborative international process for advancing both science and implementation.

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