Reimagining the Biopsychosocial Model: Transdiagnostic Factors to Precision Psychiatry.

Background: We recently reported evidence that a biopsychosocial model predicts lifetime histories of commonly comorbid early-onset psychiatric disorders. This transdiagnostic model was produced when incorporating either positron emission tomography-measured midbrain dopamine autoreceptors or functional magnetic resonance imaging (fMRI)-measured mesocorticolimbic responses during a monetary incentive delay task. Here, we tested whether a variant of this model incorporating brain responses to alcohol cues specifically predicts future alcohol problems. Methods: Forty-four youths were assessed longitudinally for externalizing (EXT) behaviors between ages 10 and 16 years, completed fMRI scans and the Childhood Trauma Questionnaire (CTQ) at age 18, and completed the Alcohol Use Disorders Identification Test (AUDIT) at age 25. Binomial logistic regressions were then run with each region of interest. Results: As hypothesized, the combination of high mesocorticolimbic responses to alcohol cues, high adolescent EXT behaviors, and high CTQ scores predicted higher AUDIT scores 7 years later. Model performance was improved by adding sex as a fourth factor. Significant mesocorticolimbic contributors to the models included the ventral ( Conclusions: Together, this work delineates a novel hierarchical model with precision psychiatry factors superimposed on transdiagnostic liability. High mesocorticolimbic reactivity to specific stimuli might shape the expression of psychopathology.