Past due: improving the naming of psychiatric disorders

The importance of proper naming - A review of Neuroscience-based Nomenclature (NbN)

Neuroscience-based Nomenclature (NbN) is a pharmacologically-driven classification of psychotropics, aiming to revise the current indication-based classification (antipsychotics, antidepressants, anxiolytics etc.). Whereas the number of psychotropics has risen dramatically over the years, the current nomenclature preserves a rather narrow categorization that overlooks the rich neurobiological knowledge accumulated to date. The current classification is confusing for the patients ("Why am I getting an 'antipsychotic' for my depression, Doctor? am I psychotic?"), and consequently interfering with optimal care. To address this issue, leading organizations in psychopharmacology have collaborated to introduce a classification which is based on pharmacological domains (neurotransmitters) and mode of action. This approach may relieve patients from confusing labels and help clinicians plan the next pharmacological step from a neuroscientific prism. NbN has earned endorsements from significant psychiatric bodies (including the American Psychiatric Association and the European Psychiatric Association) and has been incorporated into highly ranked peer-reviewed journals, textbooks, and educational programs. It is accessible through a free app, offering an easy-to-navigate database for professionals, as well as specialized versions for child and adolescent psychiatry and for patient and family education. By bridging the gap between complex neurobiological research and clinical practice, NbN may enhance evidence-based prescription practice and serve as an educational resource. Despite its inherent challenges, this initiative may represent a step towards integrating neuroscience into everyday psychiatric care, making it more understandable and relevant for all involved.

Diagnostic terms psychiatrists prefer to use for common psychotic and personality disorders

OBJECTIVE

There are ongoing discussions on updating various standard psychiatric terms, including schizophrenia, which can be confusing, and personality disorders, which can be pejorative. To contribute to this process, suggestions and recommendations on terminology were sought from academic psychiatrists with substantial clinical experience.

METHODS

In an online survey, 263 psychiatrists were asked how often they used alternative instead of standard terms for the diagnosis or symptom description of psychotic disorders and DSM Cluster B personality disorders. They were also asked what specific terms they preferred to use. Reasons for their views and choices were obtained.

RESULTS

125 clinicians (48%) responded. Only a minority of clinicians (31%) tended to use the term schizophrenia often, preferring to say psychosis or to refer to thinking and perceptual problems. Even lower proportions of clinicians (7-14%) often use the terms for Cluster B personality disorder subtypes: antisocial, narcissistic, histrionic, and borderline. Alternatives suggested for these disorders included discussing emotional dysregulation, traits of sensitivity and reactivity, and relational difficulties. Reasons cited for choosing alternative terms were to avoid miscommunication (71% of responders) and to avoid offending the patient (78% of responders).

CONCLUSIONS

There are practical alternatives to standard psychiatric terminology that may improve communication with patients and be more respectful choices, as well. The suggestions of the psychiatrists responding to this survey might be of immediate value to others in their practices and might be worthy of consideration by those writing the next versions of the standard manuals, both the DSM and the ICD.