Advancements, challenges and future horizons in personalized psychiatry
Personalized psychiatry has recently become an important component of the overall shift towards personalized medicine, aiming to address unmet medical needs in the field of mental health.
Mental disorders, particularly depression and anxiety disorders, are major contributors to the global health burden. Although various treatment options are available, they often lead to unsatisfactory outcomes. This is mainly because it is difficult to find the most effective treatment for each patient. While there are evidence-based guidelines for clinical practice, treatment recommendations are often based on the average response observed in clinical populations that participated in randomized clinical trials and do not consider specific individual characteristics.
The realization that people sharing a given diagnosis differ in several respects that are relevant to treatment response has led to a necessary move away from a one-size-fits-all approach to clinical care. Personalized psychiatry strives to integrate various patient-specific characteristics – symptoms, clinical features, neurobiological markers, genetics, epigenetics, brain imaging, environmental factors, and lifestyle – to predict susceptibility, aid diagnosis and optimize treatment to maximize efficacy and minimize adverse effects.
Recent technological innovations offer significant potential to advance the goals of personalized psychiatry. The introduction of electronic medical records simplifies the creation of extensive databases (big data). Real-time data collection via smart, wearable devices enables the recording of mental states as well as behavioral and physiological signals (digital phenotyping). In addition, the development of advanced artificial intelligence tools, such as machine learning methods, allows the recognition of intricate patterns in huge and complex data sets and thus predictions that go beyond human capabilities1.
However, despite the promising potential, the development of a personalized approach in psychiatry has been slow, mainly due to several daunting challenges. These arise from the intricate and diverse nature of psychiatric disorders, which are characterized by considerable phenomenological complexity and heterogeneity. In addition, there are no established and clear pathophysiological pathways, and psychiatric disorders exhibit multilevel dynamics that encompass biological, psychological, behavioral, social and cultural dimensions. Thus, despite the emergence of numerous predictive models with potential utility for psychiatric clinical practice, minimal progress has been made in their real-world clinical application over the past two decades2, underscoring the need for additional research and large-scale efforts.
Within this framework, the WPA launched in 2014 an innovative Scientific Section on Personalized Psychiatry, under the leadership of G. Perna, C.B. Nemeroff and A.F. Schatzberg. This pioneering initiative has attracted distinguished international experts who are active in the field as committee members, members, and speakers. Central to the Section's mandate is a commitment to harnessing advances in neuroscience, brain imaging, genetics and technology to promote the adoption of personalized approaches in all areas of mental health care.
By fostering interdisciplinary networks and collaborative research, the Section aims to unravel the complex interplay of genetic, environmental and neurobiological factors that underlie mental illness. Ultimately, the overarching goal is to equip clinicians with the tools necessary to deliver targeted psychiatric clinical interventions that benefit both professionals and patients.
Section members have conducted valuable research that contributes to this goal. Examples include identifying potential brain circuit-based biotypes for personalized treatment selection in mood disorders; translating individual-level brain circuit function into predictive markers for clinical practice3; and providing evidence that pharmacogenomics may be promising, but currently has no utility for treatment selection in major depressive disorder4. In addition, the immune system has emerged as a promising therapeutic target for certain sub-populations of people with major depression. Research is actively exploring features of immunometabolic depression as potential predictors of antidepressant treatment outcomes5, as well as proposed peripheral inflammatory biomarkers aimed at defining biotypes of unipolar and bipolar depression. An initial proposal for an evidence-based personalized therapy for panic disorder that takes into account individual phenomenological profiles and physiological patterns has been presented6, with ongoing clinical research projects actively exploring this area.
Artificial intelligence, a remarkably burgeoning field in all branches of medicine, has the capacity to assess the myriad of factors that have been found to contribute to treatment response in common mental disorders, leading to the development of reliable prediction models. Expert panels have recently published consensus guidelines for the definition of treatment resistance in anxiety disorders7 and major depressive disorder8. However, the effectiveness of these definitions for clinical decision making and health outcomes is still limited, and improvements in the therapeutic management of these disorders are needed9.
Through the promotion of international symposia, workshops and publications, our Section aims to promote knowledge exchange and collaboration among experts worldwide. In addition, it aims to collect and disseminate scientific knowledge in the field of personalized psychiatric care. These efforts have resulted in significant contributions to various scientific books. Notable works include Anxiety Disorders. Rethinking and Understanding Recent Discoveries (edited by Y.-K. Kim); Precision Psychiatry. Using Neuroscience Insights to Inform Personally Tailored, Measurement-Based Care (edited by L.M. Williams and L.M. Hack); The American Psychiatric Association Publishing Textbook of Psychopharmacology, 6th edition (edited by A.F. Schatzberg and C.B. Nemeroff); and Personalized Integrative Treatment for Depression (edited by Y.-K. Kim).
Since 2017, C.B. Nemeroff and G. Perna have been co-editors of the scientific journal Personalized Medicine in Psychiatry, a platform that grew out of their vision to create an editorial forum that allows mental health clinicians and researchers to contribute to and stay abreast of the latest advances in personalized approaches to mental health care.
In summary, by acknowledging the inherent heterogeneity and complexity of mental illness and advocating personalized approaches, this Section has attempted to lay the groundwork for a future in which each individual receives tailored treatment that addresses his/her individual needs.
However, it is clear that much more work is needed to achieve this goal. The Section will continue to advance this mission and further raise awareness of the importance of personalized approaches in the broader psychiatric community, aiming to promote implementation in practice and thus actively shaping the future landscape of psychiatric care.
