Personalized medicine in psychiatry: problems and promises

Abstract

The central theme of personalized medicine is the premise that an individual's unique physiologic characteristics play a significant role in both disease vulnerability and in response to specific therapies. The major goals of personalized medicine are therefore to predict an individual's susceptibility to developing an illness, achieve accurate diagnosis, and optimize the most efficient and favorable response to treatment. The goal of achieving personalized medicine in psychiatry is a laudable one, because its attainment should be associated with a marked reduction in morbidity and mortality. In this review, we summarize an illustrative selection of studies that are laying the foundation towards personalizing medicine in major depressive disorder, bipolar disorder, and schizophrenia. In addition, we present emerging applications that are likely to advance personalized medicine in psychiatry, with an emphasis on novel biomarkers and neuroimaging.

Figure 1

Personalized medicine. Forefront shows the schematic of the various factors that play into developing a unique phenotypic profile: genetic alterations, epigenetic modifications, clinical diagnostics, biomarker changes, and environmental changes. Upon obtaining a unique phenotypic profile, the psychiatrist is in a better position to either predict susceptibility to disease or make an accurate diagnosis. This, is in turn, allows for therapy targeted to the individual. Background: each individual will have differences in these components, giving rise to a unique phenotypic profile.

Figure 2

‘Modified’ central dogma. The central dogma of molecular biology states that DNA is transcribed to RNA, which is then translated into protein. In light of the emerging importance of non-coding RNAs, this diagram shows how non-coding RNAs serve to regulate each step in the central dogma, including regulating their own transcription.