Doença psiquiátrica geral: um marco nosográfico unificador para a psiquiatria com aplicações em psicopatologia, farmacologia, psicoterapia e cognição
DOI:
https://doi.org/10.25118/2763-9037.2026.v16.1633Palavras-chave:
doença psiquiátrica geral, nosografia, psicopatologia, comorbidade, espectro psiquiátrico, transdiagnóstico, neuropsiquiatria, farmacologia, psicoterapiaResumo
Introdução: A psiquiatria moderna tem sido dominada, há mais de quatro décadas, pelo modelo diagnóstico categorial codificado no Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM) e na Classificação Internacional de Doenças (CID).Objetivos: Introduzir e sistematizar a Doença Psiquiátrica Geral (DPG), um marco nosográfico unificador que propõe que diversas condições psiquiátricas representam expressões clínicas variáveis de um distúrbio funcional-etiopatogênico comum, e avaliar sua capacidade explicativa em cinco grandes domínios clínicos. Desenho do estudo: Revisão conceitual e síntese teórica. Metodologia: Revisão conceitual integrativa de evidências da psicopatologia, neuropsiquiatria, genética clínica, farmacologia e psicoterapia, aplicada em cinco domínios clínicos: o espectro neurodesenvolvimentista (autismo, disfasia, dislexia, TDAH), transtornos do humor, transtornos da personalidade, transtornos psicóticos e síndromes neuropsiquiátricas. Resultados: A DPG fornece uma explicação coerente de: (a) altas taxas de comorbidade psiquiátrica; (b) migração de sintomas ao longo da vida; (c) cross-categoricalidade farmacológica, e (d) arquitetura genética compartilhada entre categorias diagnósticas. O conceito, originalmente proposto em Caixeta et al. (2014, 2018), constitui o marco fundamental a partir do qual avanços em psicopatologia, farmacologia, psicoterapia e cognição podem ser sistematicamente derivados. Conclusão: A DPG representa uma mudança de paradigma na nosografia psiquiátrica. Sem substituir o diagnóstico categórico, fornece o substrato teórico para uma psiquiatria mais integrada e cientificamente produtiva, com implicações diretas para pesquisa, prática clínica, treinamento e desenvolvimento de fármacos.
Downloads
Referências
1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617-27. https://doi.org/10.1001/archpsyc.62.6.617 PMid:15939839
2. Merikangas KR, Kalaydjian A. Magnitude and impact of comorbidity of mental disorders from epidemiologic surveys. Curr Opin Psychiatry. 2007;20(4):353-8. https://doi.org/10.1097/YCO.0b013e3281c61dc5 PMid:17551350 PMCid:PMC3548397
3. Macritchie K, Geddes JR, Scott J, Haslam D, Goodwin G. Valproate for acute mood episodes in bipolar disorder. Cochrane Database Syst Rev. 2003:(1):CD004052. https://doi.org/10.1002/14651858.CD004052 PMid:12535506 PMCid:PMC6953329
4. Leucht S, Cipriani A, Spineli L, Mavridis D, Örey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lässig B, Salanti G, Davis JM. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: A multiple-treatments meta-analysis. Lancet. 2013;382(9896):951-62. https://doi.org/10.1016/S0140-6736(13)60733-3 PMid:23810019
5. Caixeta M, Caixeta L, Vargas C, Caixeta V, Canedo D, Soares R, Borges R, Caixeta C. Psiquiatria Neuropsicológica. São Paulo: Edições Sparta; 2014.
6. Caixeta M, Caixeta L, Vargas C, Caixeta V, Canedo D, Soares R, Borges R, Caixeta C. Psiquiatria Neuropsicológica (2a ed.). São Paulo: Edições Sparta; 2018.
7. Kotov R, Krueger RF, Watson D, Achenbach TM, Althoff RR, Bagby RM, Brown TA, Carpenter WT, Caspi A, Clark LA, Eaton NR, Forbes MK, Forbush KT, Goldberg D, Hasin D, Hyman SE, Ivanova MY, Lynam DR, Markon K, Miller JD, Moffitt TE, Morey LC, Mullins-Sweatt SN, Ormel J, Patrick CJ, Regier DA, Rescorla L, Ruggero CJ, Samuel DB, Sellbom M, Simms LJ, Skodol AE, Slade T, South SC, Tackett JL, Waldman ID, Waszczuk MA, Widiger TA, Wright AGC, Zimmerman M. The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. J Abnorm Psychol. 2017;126(4):454-77. https://doi.org/10.1037/abn0000258 PMid:28333488
8. McGorry PD, Hickie IB, Yung AR, Pantelis C, Jackson HJ. Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Aust N Z J Psychiatry. 2006;40(8):616-22. https://doi.org/10.1080/j.1440-1614.2006.01860.x PMid:16866756
9. Griesinger W. Die Pathologie und Therapie der psychischen Krankheiten [Internet]. Stuttgart: A. Krabbe; 1861. https://archive.org/details/diepathologieund00grie
10. Meehl PE. Schizotaxia, schizotypy, schizophrenia. Am Psychol. 1962;17(12):827-38. https://doi.org/10.1037/h0041029
11. Craddock N, Owen MJ. The Kraepelinian dichotomy, going, going... but still not gone. Br J Psychiatry. 2010;196(2):92-5. https://doi.org/10.1192/bjp.bp.109.073429 PMid:20118450 PMCid:PMC2815936
12. Insel T, Cuthbert B, Garvey M, Heinssen R, Pine DS, Quinn K, Sanislow C, Wang P. Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. Am J Psychiatry. 2010;167(7):748-51. https://doi.org/10.1176/appi.ajp.2010.09091379 PMid:20595427
13. Caspi A, Houts RM, Belsky DW, Goldman-Mellor SJ, Harrington H, Israel S, Meier MH, Ramrakha S, Sefton J, Wertz J, Poulton R, Moffitt TE. The p factor: One general psychopathology factor in the structure of psychiatric disorders? Clin Psychol Sci. 2014;2(2):119-37. https://doi.org/10.1177/2167702613497473 PMid:25360393
14. Caspi A, Houts RM, Fisher HL, Danese A, Moffitt TE. The general psychopathology factor (p): Choosing among competing models and interpreting p. Clin Psychol Sci. 2024;12(1):53-82. https://doi.org/10.1177/21677026221147872 PMid:38236494 PMCid:PMC10794018
15. Kessler RC, Berglund P, Demle, O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593-602 https://doi.org/10.1001/archpsyc.62.6.593 PMid:15939837
16. Borsboom D. A network theory of mental disorders. World Psychiatry. 2017;16(1):5-13. https://doi.org/10.1002/wps.20375 PMid:28127906
17. Cross-Disorder Group of the Psychiatric Genomics Consortium. Genetic relationship between five psychiatric disorders estimated from genome-wide SNPs. Nat Genet. 2013;45(9):984-94. https://doi.org/10.1038/ng.2711 PMid:23933821
18. Smoller JW, Craddock N, Kendler K, Lee PH, Neale BM, Nurnberger JI, Ripke S, Santangelo S, Sullivan PF, Cross-Disorder Group of the Psychiatric Genomics Consortium. Identification of risk loci with shared effects on five major psychiatric disorders: A genome-wide analysis. Lancet. 2013;381(9875):1371-79. https://doi.org/10.1016/S0140-6736(12)62129-1 PMid:23453885
19. Guillen-Burgos HF, Vanegas V, Gonzalez I, Caicedo AM, Arango V, Galvez-Florez JF, Anaya J-M, McIntyre RS, Terán W. Shared genetic architecture among severe mental disorders: A system biology approach based on protein-protein interaction. Brain Behav. 2025;15(9):e70742. https://doi.org/10.1002/brb3.70742 PMid:40922454 PMCid:PMC12417566
20. Cipriani A, Pretty H, Hawton K, Geddes JR. Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: A systematic review of randomized trials. Am J Psychiatry. 2005;162(10):1805-19. https://doi.org/10.1176/appi.ajp.162.10.1805 PMid:16199826
21. Nelson JC, Papakostas GI. Atypical antipsychotic augmentation in major depressive disorder: a meta-analysis of placebo-controlled randomized trials. Am J Psychiatry. 2009;166(9):980-91 https://doi.org/10.1176/appi.ajp.2009.09030312 PMid:19687129
22. Rapin T. Developmental dysphasia and autism in pre-school children: characteristics and subtypes. In: Proceedings of the First International Symposium on Specific Speech and Language Disorders in Children. London: AFASIC, 1987.
23. Baker L, Cantwell DP. A prospective psychiatric follow-up of children with speech/language disorders. J Am Acad Child Adolesc Psychiatry. 1987;26(4):546-53. https://doi.org/10.1097/00004583-198707000-00015 PMid:3654509
24. Gérard C-L. L'enfant dysphasique. Paris: Éditions Universitaires; 1993. https://doi.org/10.3917/dbu.gerar.1993.01
25. Dinstein I, Thomas C, Behrmann M, Heeger DJ. A mirror up to nature. Curr Biol. 2008;18(1):R13-8. https://doi.org/10.1016/j.cub.2007.11.004 PMid:18177704 PMCid:PMC2517574
26. Akiskal HS, Pinto O. The evolving bipolar spectrum: Prototypes I, II, III, and IV. Psychiatric Psychiatr Clin North Am. 1999;22(3):517-34. https://doi.org/10.1016/S0193-953X(05)70093-9 PMid:10550853
27. Trull TJ, Durrett CA. Categorical and dimensional models of personality disorder. Annu Rev Clin Psychol. 2005:1:355-80. https://doi.org/10.1146/annurev.clinpsy.1.102803.144009 PMid:17716092
28. Fonagy P, Luyten P. A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol. 2009;21(4):1355-81. https://doi.org/10.1017/S0954579409990198 PMid:19825272
29. Barlow DH, Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Allen LB, Ehrenreich-May J. Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. Oxford: Oxford University Press; 2011. https://doi.org/10.1093/med:psych/9780199772667.001.0001
30. van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L. A systematic review and meta-analysis of the psychosis continuum: Evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychol Med. 2009;39(2):179-95. https://doi.org/10.1017/S0033291708003814 PMid:18606047
31. Rizzolatti G, Craighero L. The mirror-neuron system. Annu Rev Neurosci. 2004:27:169-92. https://doi.org/10.1146/annurev.neuro.27.070203.144230 PMid:15217330 PMCid:PMC13444769
32. Hickok G. Eight problems for the mirror neuron theory of action understanding in monkeys and humans. J Cogn Neurosci. 2009;21(7):1229-43. https://doi.org/10.1162/jocn.2009.21189 PMid:19199415 PMCid:PMC2773693
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2026 Giovanna Azevedo Rodrigues, Fernando Martins Castanheira Júnior, Marcelo Ferreira Caixeta
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial 4.0 International License.
Debates em Psiquiatria permite que o (s) autor (es) mantenha(m) seus direitos autorais sem restrições. Atribuição-NãoComercial 4.0 Internacional (CC BY-NC 4.0) - Debates em Psiquiatria é regida pela licença CC-BY-NC
