Current nosology for the diagnosis of neuropsychiatric disorders separates each disorder often into non-overlapping diagnostic categories. This nosological separation is not based on underlying aetiology but on convention-based clustering of qualitative symptoms of disorders. Yet, overlap in disease symptoms and dimensions across different neuropsychiatric disorders is huge, leading to considerable comorbidity between disorders.

While diagnostic categories are sufficient to provide the basis for general clinical management, they do not describe the underlying neurobiology that gives rise to individual symptoms. The ability to precisely link these symptoms to underlying neurobiology would not only facilitate the development of new and more precise treatments – which are urgently needed given the unsatisfyingly low response and remission rates of current treatments of all modalities – it would also allow physicians to provide patients with a better understanding of the complexities and management of their illness. To realise this ambition, a paradigm shift is needed to build an understanding of how neuropsychiatric conditions can be defined more precisely using quantitative, multimodal biological and environmental processes and parameters and thus to optimise treatment efficacy.

Precision psychiatry has been introduced as a new approach to improve treatment of mental disorders and to develop innovative, mechanism-based treatment strategies beyond the current diagnostic boundaries. At its core, precision psychiatry is an approach that focuses on understanding the underlying neurobiological mechanisms that cause the symptoms of mental health conditions. Using this understanding, it aims to develop therapies that can target these mechanisms, which in turn will address previously untreatable aspects of mental health conditions by providing more specific symptom control and possibly altering the trajectory of the disease process. However, this new approach would result in a radically different diagnostic system, abandoning the classical clinical approach, and posing significant challenges for clinicians, industry, and regulators alike.

The ECNP Roadmap Initiative aims to reach a consensus roadmap for building a new diagnostic framework for mental disorders that will instantiate a set of principles and procedures by which research can continuously improve precision diagnostics. The initiative seeks to achieve global alignment with all stakeholders on the way forward to better define and (longitudinally) measure neuropsychiatric conditions, harmonise (translational) methodologies and data sets across the community, and mobilise resources to implement and validate the framework.