Redefining phenotypes to advance psychiatric genetics: Implications from hierarchical taxonomy of psychopathology

Genetic discovery in psychiatry and clinical psychology is hindered by suboptimal phenotypic definitions. We argue that the hierarchical, dimensional, and data-driven classification system proposed by the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium provides a more effective approach to identifying genes that underlie mental disorders, and to studying psychiatric etiology, than current diagnostic categories. Specifically, genes are expected to operate at different levels of the HiTOP hierarchy, with some highly pleiotropic genes influencing higher order psychopathology (e.g., the general factor), whereas other genes conferring more specific risk for individual spectra (e.g., internalizing), subfactors (e.g., fear disorders), or narrow symptoms (e.g., mood instability). We propose that the HiTOP model aligns well with the current understanding of the higher order genetic structure of psychopathology that has emerged from a large body of family and twin studies. We also discuss the convergence between the HiTOP model and findings from recent molecular studies of psychopathology indicating broad genetic pleiotropy, such as cross-disorder SNP-based shared genetic covariance and polygenic risk scores, and we highlight molecular genetic studies that have successfully redefined phenotypes to enhance precision and statistical power. Finally, we suggest how to integrate a HiTOP approach into future molecular genetic research, including quantitative and hierarchical assessment tools for future data-collection and recommendations concerning phenotypic analyses. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Billing effectively with the new health and behavior current procedural terminology codes in primary care and specialty clinics

The health and behavior current procedural terminology (CPT) codes introduced in 2003 have gained nationwide acceptance through Medicare and limited acceptance through third party payers. The codes facilitate accurate description and quantification of behavioral medicine services within a primary care or specialty clinic setting. The author reviews their appropriate utilization to enhance reimbursement and facilitate development of self-sustaining behavioral medicine programs. Information is provided on increased use and reimbursement of codes within psychology. Future directions for continued advocacy, increased acceptance, training, and research are discussed.

Defining psychology: is it worth the trouble?

Henrique's thoughtful effort (this issue) to define psychology suffers from at least three shortcomings: (a) "psychology" is almost certainly an inherently fuzzy concept that resists precise definition; (b) attempts to define psychology are likely to hamper rather than foster consilience across scientific disciplines; and (c) Henriques incorrectly diagnoses the cause of the scientist-practitioner gap and hence offers an incorrect prescription. The sources of this gap lie not in intractable definitional disputes, but in fundamentally different approaches to acquiring knowledge.

The unification of psychology and psychological organizations

The Tree of Knowledge is an imaginative attempt to construct a metatheoretical system that proposes to unify the discipline of psychology. However, it is limited in its appreciation of political factors, and so an optimistic view of the possibility of the system overlooks the power issues that beset the field.

Unity within psychology, and unity between science and practice

The unity of psychology as a science is to be found in its definition as the science of mental life, and its explanation of individual behavior in terms of mental states. This disciplinary focus will help negotiate psychology's relations with other disciplines, such as neuroscience and cognitive science. The unity within psychology between science and practice is to be found in a focus on scientific evidence as the source of the status, autonomy, and privileges of professional practitioners. Psychology should avoid the temptations of reductionism, and assert (and enjoy) its twin status as both a biological science and a social science.

Training professional psychologists for the twenty-first century

The continued growth and development of professional psychology may ultimately stand or fall on the integrity of the educational system that prepares future generations of practitioners. Currently, the educational enterprise is unduly hampered by several significant impediments. These impediments are identified and resolutions are proposed that would, if implemented, greatly enhance psychology's ability to assume its rightful place as a major autonomous profession that is properly positioned to address some of the nation's pressing social needs.