Diagnosis

The current system for the diagnosis of CNS disorders in the USA is DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision).3 This text, which has a long and chequered history,4 'facilitates the identification and management of mental disorders' to help provide a consensus view of these disorders and their treatment, and a better understanding of their etiology. The general classification of mental disorders that comprise DSM-IV-TR is shown in Table 1 where the major headings are shown with illustrative data, where appropriate, on the syndromes within each heading. These diagnostic criteria lack a specific etiological conceptualization3 and are thus organized principally around syndromes - a group or pattern of symptoms that appear in individuals in a temporal manner - reflecting, to a major extent, comorbidities. However DSM-IV-TR is confounded by ethnic, societal, and gender differences both in terms of diagnosis (physician) and disease (patient). Thus in the postgenomic era, it is anticipated that DSM-V due to be published in 2011 (or later) will incorporate disease genotypes as part of the diagnostic tree. Given that over 30 gene associations have been shown to date for schizophrenia, the challenge will be in incorporating these into a cohesive framework and avoid having 14 or more categories of schizophrenia based on gene association. One issue with genome-based disease association is that many of the diseased patient cohorts used for genotyping represent historical diagnoses from more than one physician or geographical center, a problem that can confound inclusion criteria.

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Blood Pressure Health

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