The new field of 'precision psychiatry'

Abstract

Background: Precision medicine is a new and important topic in psychiatry. Psychiatry has not yet benefited from the advanced diagnostic and therapeutic technologies that form an integral part of other clinical specialties. Thus, the vision of precision medicine as applied to psychiatry - 'precision psychiatry' - promises to be even more transformative than in other fields of medicine, which have already lessened the translational gap.

Discussion: Herein, we describe 'precision psychiatry' and how its several implications promise to transform the psychiatric landscape. We pay particular attention to biomarkers and to how the development of new technologies now makes their discovery possible and timely. The adoption of the term 'precision psychiatry' will help propel the field, since the current term 'precision medicine', as applied to psychiatry, is impractical and does not appropriately distinguish the field. Naming the field 'precision psychiatry' will help establish a stronger, unique identity to what promises to be the most important area in psychiatry in years to come.

Conclusion: In summary, we provide a wide-angle lens overview of what this new field is, suggest how to propel the field forward, and provide a vision of the near future, with 'precision psychiatry' representing a paradigm shift that promises to change the landscape of how psychiatry is currently conceived.

Keywords: Big data; Biomarkers; Omics; Personalised medicine; Precision medicine; Precision psychiatry; Research domain criteria; Systems biology.

Fig. 1

Domains related to ‘precision psychiatry’. Diverse approaches and techniques, such as ‘omics’, neuroimaging, cognition and clinical characteristics, converge to several domains. These domains can be analysed using systems biology and computational psychiatry tools to produce a biosignature – a set of biomarkers – that, when applied to individuals and populations, will produce better diagnosis, endophenotypes (measurable components unseen by the unaided eye along the pathway between disease and distal genotype), classifications and prognosis, as well as tailored interventions for better outcomes. The bottom-up approach from specific areas (such as metabolomics) to domains (such as molecular biosignature), to systems biology and computational psychiatry, to a resultant biosignature, can also be reverted to a top-down approach, with specific biosignatures being analysed to better understand domains and its specific components. Components and domains are not mutually exclusive, and a subject can belong to more than one component or domain; for instance, ‘large databanks’ can belong to data from ‘neuroimaging’, ‘mobile devices’ and ‘panomics’, all of which are put as different domains. After the establishment of precision psychiatry, persons considered to belong to the same group (agglomerate of persons in grey) will be reclassified into different diagnosis and endophenotypes. Further, after accomplishing precision psychiatry, it will be possible to more accurately predict response or non-response to treatment, as well as better prognosis