Mental disorders of known aetiology and precision medicine in psychiatry: a promising but neglected alliance

Abstract

Personalized or precision medicine is predicated on the assumption that the average response to treatment is not necessarily representative of the response of each individual. A commitment to personalized medicine demands an effort to bring evidence-based medicine and personalized medicine closer together. The use of relatively homogeneous groups, defined using a priori criteria, may constitute a promising initial step for developing more accurate risk-prediction models with which to advance the development of personalized evidence-based medicine approaches to heterogeneous syndromes such as schizophrenia. However, this can lead to a paradoxical situation in the field of psychiatry. Since there has been a tendency to loosely define psychiatric disorders as ones without a known aetiology, the discovery of an aetiology for psychiatric syndromes (e.g. 22q11.2 deletion syndrome in some cases of schizophrenia), while offering a path toward more precise treatments, may also lead to their reclassification away from psychiatry. We contend that psychiatric disorders with a known aetiology should not be removed from the field of psychiatry. This knowledge should be used instead to guide treatment, inasmuch as psychotherapies, pharmacotherapies and other treatments can all be valid approaches to mental disorders. The translation of the personalized clinical approach inherent to psychiatry into evidence-based precision medicine can lead to the development of novel treatment options for mental disorders and improve outcomes.

Keywords: 22q11.2 deletion syndrome; Personalized medicine; psychiatry; risk-prediction models; schizophrenia.

Conflict of interest statement

Declaration of Interest David Fraguas has been a consultant and/or advisor to or has received honoraria from AstraZeneca, Bristol-Myers Squibb, Janssen, Lundbeck, Otsuka, and Pfizer. Covadonga M. Díaz-Caneja has previously held a Río Hortega grant, Instituto de Salud Carlos III, Spanish Ministry of Economy and Competitiveness, and a grant from Fundación Alicia Koplowitz. Matthew W. State serves on scientific advisory boards for Pfizer Pharmaceuticals, Blackthorn Therapeutics and SynapDx. Michael C. O’Donovan has received a consultancy fee from Roche in return for advice on the implications of current genetic findings in psychiatry. Celso Arango has been a consultant to or has received honoraria or grants from Abbott, Amgen, AstraZeneca, Bristol-Myers Squibb, Caja Navarra, CIBERSAM, Fundación Alicia Koplowitz, Instituto de Salud Carlos III, Janssen-Cilag, Lundbeck, Merck, Ministerio de Ciencia e Innovación, Ministerio de Sanidad, Ministerio de Economía y Competitividad, Mutua Madrileña, Otsuka, Pfizer, Roche, Servier, Shire, Takeda, and Schering-Plough. Raquel E. Gur has no conflict of interest to declare.