The Role of Precision Medicine in Child Psychiatry: What Can We Expect and When?

Abstract

In the United States, nearly 1 in 5 adults and 1 in 4 children suffer with a mental illness, and for most, these illnesses confer significant social, occupational, or academic impairment.^1,2 Whereas considerable progress has been made toward diminishing the impact of mental illness, in the last few decades, advances toward new, more effective, and more refined psychiatric treatments have slowed. First-line medications for depression, schizophrenia, bipolar disorder, and attention-deficit/hyperactivity disorder (ADHD) were all introduced decades ago,^3-6 and little progress has been made in augmenting their effectiveness.^7,8.

FIGURE 1

Comparison of Current Psychiatric Practice With Precision Medicine Note: (A) In current psychiatric practice, treatments are selected on the basis of diagnoses or syndromes, which may encompass heterogeneous disease processes, or underlying pathophysiology. This heterogeneity is represented here by blue, red, and green stick figures. For example, children with autism spectrum disorders (ASD) are provided treatments based on their diagnosis and symptoms, not on the basis of the etiology of ASD. (B) Precision medicine aims to match treatments with disease processes. Although this goal has not yet been achieved, children with ASD could, in theory, be divided into subgroups based on de novo mutations that give rise to the disorder, represented here as stick figures sorted by color in the column labeled “Genetic variants.” Targeted treatments could then be offered to address the pathophysiology related to the de novo mutation, represented here in the column labeled “Precision medicines.”