From run-to-failure to condition-based care: a multi-domain framework for preventive psychiatry

= 7,201), that shorter duration of untreated illness is associated with 70% greater likelihood of treatment response, and that early intervention for first-episode psychosis reduces hospitalisation by 26%. We review convergent evidence across five modifiable domains - sleep and glymphatic clearance, nutritional psychiatry, allostatic load regulation, autonomic function, and psychoneuroimmunological monitoring - selected for objective measurability, meta-analytic interventional support, identified mechanistic pathways, and population-level scalability. These domains form a mechanistically interconnected network in which deterioration in one can cascade across others. Clinical staging models, adapted from oncology, provide the graduated diagnostic architecture for condition-based care. We present a speculative multi-domain monitoring protocol with parameters, frequencies, and action thresholds calibrated to clinical stage. Among the five domains, inflammatory monitoring via C-reactive protein emerges as the most implementation-ready, with established clinical thresholds, demonstrated treatment-selection utility, and symptom-specific associations with neurovegetative features consistent with an immuno-metabolic depression subtype. Prospective multi-domain monitoring trials are identified as the most urgent research priority.