Precision medicine in psychiatry

What is it about?

Mental disorders are among the most detrimental disorders worldwide. They are associated with high personal and societal burden with increasing sick leave and early retirement that reflects insufficient treatment options. Unlike other disciplines in medicine, the diagnostic process and the choice of treatment are solely based on clinical judgment, without incorporating objective measures. Therefore, precision medicine should help matching individual patients with the most effective treatments while minimizing the risk of adverse events. The aim of precision medicine is to improve the diagnostic process and the choice of a specific treatment using genetic markers or biomarkers derived from peripheral blood, imaging, electroencephalographic measures or neuropsychological tests. In this review, several concepts of biomarker research to enable precision medicine are described. The analysis of the genetic makeup and the acknowledgement of the crucial interaction of genetic variants with environmental factors have already delivered promising predictors. Current concepts focus amongst others on the moleculargenetic alterations of systems activated by stress, such as the stress-hormone-system (hypothalamic-pituitary-adrenal axis) or the immune system. In addition, electronic devices and neuropsychological tests are described that help stratify subgroups of patients and thus help to deliver a tailored treatment. The assessment of the genetic makeup, environmental factors including lifestyle and markers derived from the stress-systems also delivers predictors to identify individuals at risk, thus precision medicine will also set up preventive strategies to reduce the risk of developing a mental disorder.

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Why is it important?

This article gives an overview of concepts to develop an individualized approach in psychiatry, ranging from individualized preventive strategies to patient-tailored treatments.

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