Personalized psychiatry: achievements and prospects

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The use of antipsychotics in targeted therapy of schizophrenia — prospects and challenges (for example, amisulpride).

Personalized medicine is an innovative approach that takes into account the biological, social and psychological characteristics of people in the development of preventive drugs and treatment of diseases. The goals of personalized medicine in psychiatry are to anticipate a person’s susceptibility to disease, achieve accurate diagnosis, and facilitate a favorable response to treatment. This article analyzes the information presented in the literature on use of antipsychotics in treatment of schizophrenia from the standpoint of personalized medicine with the aim to draw up recommendations for improving the effectiveness of psychotic symptoms therapy and set the vector for further scientific research in this direction. Despite the existence of many international and local guidelines and protocols for antipsychotic therapy, there is still the problem of early determination of which antipsychotic will be effective and safe for a particular patient — before the most effective drug is determined, patients are usually treated with various antipsychotics. In the treatment of schizophrenia, no antipsychotic drug or dosage is universal. Therefore, to maximize the useful effect and minimize the risk of side effects, numerous individual characteristics of each individual user must be considered. In particular, such characteristics as sex, age, clinical features (dominant symptoms, time of onset of symptoms and their intensity), comorbid mental and somatic disorders, presence/absence of bad habits, response to previous therapy (in case of such) should be taken into account. Given the possibility of flexible dosage of amisulpride and its significant effectiveness in reducing various groups of symptoms in various categories of patients, it has the potential for widespread use in personalized psychiatry. Key words personalized medicine, atypical antipsychotics, effectiveness of therapy

Consumer Participation in Personalized Psychiatry

Personalized psychiatry represents a paradigm shift that is long overdue. It is characterized by shifting screening, diagnosis, treatment, and prevention practices away from a “one size fits all” approach to one tailored to patients’ unique clinical, social, digital, and biological (e.g., genetic and epigenetic) profiles to enhance outcomes. This shift from traditional approaches to more tailored, personalized practices not only opens up an opportunity for, but also emphasizes the need for consumer participation in the design of these practices. This participation could be through research, policy, ethics discussions, clinical care, or novel solution development. This chapter outlines the rationale for consumer participation in personalized psychiatry and provides insights and examples of ways in which to enhance this participation. The outcome is novel solution development that appropriately focuses on end-user needs by incorporating consumer contributions to both product design as well as testing. Validation of new technologies prior to their implementation can be difficult through current research practices; however, consumers can help expand research practices by identifying the highest-priority questions to answer, advocating for necessary resources and influencing the design of models for joint clinical decision-making. As both research subjects and the ultimate beneficiaries or users of new technologies, consumers also have a critical perspective on ethical issues unique to personalized psychiatry—one that absolutely needs to be considered as this field continues to grow. The authors conclude that there is no substitute for the consumer voice.

‘Precision psychiatry’ needs to become part of ‘personalized psychiatry’

Abstract‘Precision medicine’ is defined as ‘an emerging approach for treatment and prevention that takes into account each person’s variability in genes, environment, and lifestyle’. Sometimes the term ‘personalized medicine’ is also used, either as a synonym or in a broader sense. In psychiatry, the term ‘personalized’ applies to different levels of health-care provision, such as the service organization and the choice of treatment plans based on the characterization of the individual patient. This approach is already feasible but, currently, it is often hampered by the shortage of human and financial resources. Recently, the terminology of ‘precision medicine’ has been extended to psychiatry: the term ‘precision psychiatry’ refers to the full exploitation of recent scientific and technological advances to achieve a close match between individual biosignature and prevention / treatment strategies. This article provides an overview of recent advances in neuroimaging, multi-omics and computational neuroscience, which have contributed to foster our understanding of the neurobiology of major mental disorders, and led to the implementation of a precision medicine-oriented approach in psychiatry.We argue that, while ‘precision psychiatry’ represents an important step to further advance the effectiveness of the ‘personalized psychiatry’, the distinction between the two terms is important to avoid dangerous neglect of the current potential of personalized care in psychiatry and to underscore the need for disseminating good existing practices aimed at organizing mental health services and providing care according to person’s psychopathological characteristics, illness trajectory, needs, environment and preferences.In conclusion, ‘precision psychiatry’ will contribute to advance ‘personalized psychiatry’, but for the time being keeping the distinction between the two terms will contribute to fully exploit the current potential of personalized care.

‘Precision’ or ‘personalized’ psychiatry: different terms – same content?

Due to the increased lifetime prevalence and personal, social, and economic burden of mental disorders, psychiatry is in need of a significant change in several aspects of its clinical and research approaches. Over the last few decades, the development of personalized / precision medicine in psychiatry focusing on tailored therapies that fit each patient’s unique individual, physiological, and genetic profile has not achieved the same results as those obtained in other branches, such as oncology. The long-awaited revolution has not yet surfaced. There are various explanations for this including imprecise diagnostic criteria, incomplete understanding of the molecular pathology involved, absence of available clinical tools and, finally, the characteristics of the patient. Since then, the co-existence of the two terms has sparked a great deal of discussion around the definition and differentiation between the two types of psychiatry, as they often seem similar or even superimposable. Generally, the two terminologies are used indiscriminately, alternatively, and / or separately, within the same scientific works. In this paper, an overview is provided on the overlap between the application and meaning of the terms ‘precision psychiatry’ and ‘personalized psychiatry’.

Precision and personalized assessment, diagnosis and treatment in psychiatry

“Precision medicine” and “personalized medicine” constitute goals of research since antiquity and this was intensified with the arrival of the “evidence-based medicine.” precision and personalized psychiatry (3P) when achieved will constitute a radical shift in our paradigm and it will be even more transformative than in other fields of medicine. The biggest problems so far are the problematic definition of mental disorder, available treatments seem to concern broad categories rather than specific disorders and finally clinical predictors of treatment response or side effects and biological markers do not exist. Precision and personalized psychiatry like all precision medicine will be a laborious and costly task; thus the partnership of scientists with industry and the commercialization of new methods and technologies will be an important element for success. The development of an appropriate legal framework which will both support development and progress but also will protect the rights and the privacy of patients and their families is essential.

Personalized Psychiatry and Depression: The Role of Sociodemographic and Clinical Variables

Despite several pharmacological options, the clinical outcomes of major depressive disorder (MDD) are often unsatisfactory. Personalized psychiatry attempts to tailor therapeutic interventions according to each patient’s unique profile and characteristics. This approach can be a crucial strategy in improving pharmacological outcomes in MDD and overcoming trial-and-error treatment choices. In this narrative review, we evaluate whether sociodemographic (i.e., gender, age, race/ethnicity, and socioeconomic status) and clinical [i.e., body mass index (BMI), severity of depressive symptoms, and symptom profiles] variables that are easily assessable in clinical practice may help clinicians to optimize the selection of antidepressant treatment for each patient with MDD at the early stages of the disorder. We found that several variables were associated with poorer outcomes for all antidepressants. However, only preliminary associations were found between some clinical variables (i.e., BMI, anhedonia, and MDD with melancholic/atypical features) and possible benefits with some specific antidepressants. Finally, in clinical practice, the assessment of sociodemographic and clinical variables considered in our review can be valuable for early identification of depressed individuals at high risk for poor responses to antidepressants, but there are not enough data on which to ground any reliable selection of specific antidepressant class or compounds. Recent advances in computational resources, such as machine learning techniques, which are able to integrate multiple potential predictors, such as individual/ clinical variables, biomarkers, and genetic factors, may offer future reliable tools to guide personalized antidepressant choice for each patient with MDD.