Personalized Medicine
How Precision Psychiatry Works
Precision psychiatry must factor in a huge number of variables and their interaction to understand the nature of a person’s disorder and to target treatment. Well-established variables include symptom expression, brain circuit function, physiology, cognitive function, genetic makeup, and past and current life experience. Diet , environment, activity levels, and sleep patterns are emerging as important factors. As precision psychiatry reveals how the many elements interact to cause illness and distress, it also promises to indicate many possible points of therapeutic intervention.
However intangible psychiatric symptoms may sometimes seem, they are all the product of some neurobiological process. Biomarkers (biological markers) are objective, usually laboratory-based measurements of specific body molecules and processes that are used as indicators of health and disease. As objective, physically based measures, they are distinct from symptoms, which are indicators perceived by patients themselves. Researchers search for biomarkers or constellations of biomarkers that can be considered the signature of specific conditions. Measurement of biomarkers associated with specific medical conditions is often used not just to determine the presence of illness, or susceptibility to it, but to suggest effective treatment and to gauge treatment response.
Psychiatry has long sought to identify and validate biomarkers of brain and mental health, and biomarkers are thought to be necessary for the advancement of precision psychiatry. For millions of people who currently undergo pharmacotherapy for depression , for example, treatment usually involves a trial-and-error process with different drugs, several rounds of therapeutic failure, unpleasant or intolerable side effects, and many months before there is any relief, if at all. Researchers are now actively testing whether biomarkers of nerve-connectivity patterns in various brain circuits could help identify which people are most likely to respond to various kinds of antidepressants . Genomic testing can also yield information about who is more likely to respond to classes of drugs or specific drugs.
Psychiatric researchers are currently exploring possible biomarkers not just for depression but for mental health conditions as diverse as anxiety , PTSD , eating disorders, bipolar disorder , substance use disorders, autism , schizophrenia, and suicidality . Candidates include the presence or absence of specific genes and variants, levels of specific inflammatory molecules, the strength of various signals measured on EEGs, connectivity patterns in functional brain circuits seen in brain imaging, activity patterns of specific brain structures such as the amygdala detectable through brain imaging, and more.
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