A principal weakness of evidence-based psychiatry is that it does not account for the individual variability in therapeutic response among individuals with the same diagnosis. The aim of personalized psychiatry is to remediate this shortcoming and to use predictors to select treatment that is most likely to be beneficial for an individual. This article reviews the evidence that genetic variation, environmental exposures, and gene-environment interactions shape mental illness and influence treatment outcomes, with a primary focus on depression.
While for other complex disorders like cancer a limited number of markers are at hand, there are currently no biomarkers available for major depression. A major goal is therefore the identification of biomarkers that can categorize subsets of patients in a consistent manner. Biomarkers for mood disorders provides discovery strategies from scientists in academia and pharma and biotech industries. This will allow a more precise definition of psychiatric disorders and in turn facilitate investigations of the pathophysiology and enhance the ability for patient treatment.
WHAT IS KNOWN AND OBJECTIVE: Psychotherapy has traditionally competed with psychopharmacology. As drugs have become the more dominant treatment in psychiatry and primary care, this approach is increasingly criticized as limited in scope, lacking in robust outcomes and too heavily influenced by the pharmaceutical industry. Our objective is to show that recent advances in neurobiology are clarifying that learning and environmental experiences, such as psychotherapy, change brain circuits as do drugs.
Journal of Psychosocial Nursing and Mental Health Services
Understanding pharmacogenetic differences in drug response and tolerability has been an important area of research in personalized medicine, but the clinical utility of pharmacogenetics testing has not been established. Identification of genetic polymorphisms due to single nucleotide polymorphisms is the most common approach, but this does not take into account the potential relevance of copy number variants, noncoding RNA gene regulation, gene-gene and gene-interactions, and epigenetic modifications, which increase the complexity of pharmacogenomics research.
The neurotransmitter dopamine (DA) plays a central role in addictive disorders, including nicotine addiction. Specific DA-related gene variants have been studied to identify responsiveness to treatment for nicotine addiction. Genetic variants in DRD2, DRD4, ANKK1, DAT1, COMT and DBH genes show some promise in informing personalized prescribing of smoking cessation pharmacotherapies. However, many trials studying these variants had small samples, used retrospective design or were composed of mainly self-identified Caucasian individuals.
Nuclear transplantation, cell fusion, and induced pluripotent stem cell studies have revealed a surprising degree of plasticity in mature mammalian cell fates. Somatic cell reprogramming also has been achieved more recently by the directed conversion of nonneuronal somatic cells, such as skin fibroblasts, to neuronal phenotypes. This approach appears particularly applicable to the in vitro modeling of human neurologic disorders.
European Neuropsychopharmacology: The Journal of the European College of Neuropsychopharmacology
In bipolar disorders, there are unclear diagnostic boundaries with unipolar depression and schizophrenia, inconsistency of treatment guidelines, relatively long trial-and-error phases of treatment optimization, and increasing use of complex combination therapies lacking empirical evidence. These suggest that the current definition of bipolar disorders based on clinical symptoms reflects a clinically and etiologically heterogeneous entity.
Some of the latest advances in personalized psychiatry with future research directions are discussed in this article. Many factors contribute to the phenotypic psychiatric profile in individual patients. These overlapping factors include but are not limited to genetics, epigenetics, central nervous system circuit alterations, family history, past personal history, environmental influences including early life stress, and more recent life stressors. The authors discuss the role of pharmacogenomics, particularly in the cytochrome P450 enzyme system in relation to treatment response.
OVERVIEW: Hospitalized patients who are suffering from cognitive impairment, delirium, suicidal ideation, traumatic brain injury, or another behavior-altering condition are often placed under continuous observation by designated "sitters." These patients may become agitated, which can jeopardize their safety even when a sitter is present. This quality improvement project was based on the hypothesis that agitation can be decreased by engaging these patients in individualized therapeutic activities.
The promise of personalized medicine depends on the ability to integrate genetic sequencing information into disease risk assessment for individuals. As genomic sequencing technology enters the realm of clinical care, its scale necessitates answers to key social and behavioral research questions about the complexities of understanding, communicating, and ultimately using sequence information to improve health.