Knowledge gaps related to the clinical utility of the hierarchical taxonomy of psychopathology (HiTOP) : a scoping review

Abstract

Objective: The aim of this scoping review was to determine the extent and type of literature in relation to the clinical utility of the Hierarchical Taxonomy of Psychopathology (HiTOP), with a particular focus on identifying gaps where new primary research is needed. Introduction: Recently, HiTOP has gained popularity as an alternative to categorical psychiatric nosologies and is hypothesized to offer better clinical utility. However, the evidence for this claim is currently limited yet nascent. Inclusion criteria: This review considered published and gray primary studies reporting on the clinical utility of HiTOP, irrespective of participant and context characteristics. The search sought documents published from 2017 onwards, corresponding with the publication of the seminal paper introducing HiTOP. Methods: The JBI approach for conducting and reporting scoping reviews was followed. A three-step search strategy was used to locate both published and unpublished literature. An initial search of PubMed and OSFpreprints identified keywords. A second search of PubMed, Scopus and OSFpreprints followed. The author screened and selected eligible articles, and extracted data from them, supported by the supervisor. In total, 4 studies were included. Analysis: Little evidence exists that reports on the clinical utility of HiTOP. Across the board, the main concern was the generalizability of findings on HiTOP’s utility across all settings and populations that are impacted by psychiatric classifications. Additionally, research designs on the clinical utility of HiTOP lacked the application of HiTOP in real-world settings, the use of RCT designs, and the recruitment of participants who are critical of HiTOP. Concerning the domain of clinical utility outcomes, patient-reported measures of communication were not used, and HiTOP was not assessed for performance on the tasks of reimbursement, application in a reasonable time, stigmatization reduction, and specificity of the diagnoses it generates. Only selective dimensions of HiTOP were assessed, without reliance on a measurement-based approach. HiTOP’s separation of impairment from symptom assessment was not tested for its utility and feasibility. Finally, HiTOP was only compared to certain DSM-5 diagnoses, warranting a future focus on ICD-11 and the hybrid AMPD/DSM-5 model as comparators.