Overview Psychiatric medicine is now advancing from solely descriptive disease classification toward a biologically based taxonomy. This evolution is more protracted than for other branches of medicine given the complexity of the neural systems that underlie human mental function and the challenge of characterizing psychiatric phenotypes objectively and quantitatively. The ultimate goal of this exercise is to describe the mechanistic and phenotypic variability within and across traditional diagnostic boundaries in a manner that identifies risk and resilience factors, provides early detection, predicts clinical outcomes, and specifies targets for trajectory-altering therapeutics and prevention. The DSM-III classification of the American Psychiatric Association has been helpful in this regard by standardizing the assessment of symptoms and syndromes in a multifactorial, biopsychosocial context. Additionally, the Research Domain Criteria of the National Institute of Mental Health emphasize moving toward studying intermediate phenotypes (eg, endophenotypes and vide infra). While helpful when implemented as suggested in the Research Domain Criteria, the characterization of these endophenotypes may be too limited and not fully integrative. The heterogeneity within traditional diagnoses and the comorbidity among diagnoses require a more multidimensional molecular approach.
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