‘Precision’ or ‘personalized’ psychiatry: different terms – same content?

Abstract

Due to the increased lifetime prevalence and personal, social, and economic burden of mental disorders, psychiatry is in need of a significant change in several aspects of its clinical and research approaches. Over the last few decades, the development of personalized / precision medicine in psychiatry focusing on tailored therapies that fit each patient’s unique individual, physiological, and genetic profile has not achieved the same results as those obtained in other branches, such as oncology. The long-awaited revolution has not yet surfaced. There are various explanations for this including imprecise diagnostic criteria, incomplete understanding of the molecular pathology involved, absence of available clinical tools and, finally, the characteristics of the patient. Since then, the co-existence of the two terms has sparked a great deal of discussion around the definition and differentiation between the two types of psychiatry, as they often seem similar or even superimposable. Generally, the two terminologies are used indiscriminately, alternatively, and / or separately, within the same scientific works. In this paper, an overview is provided on the overlap between the application and meaning of the terms ‘precision psychiatry’ and ‘personalized psychiatry’.

Zusammenfassung

Aufgrund der zunehmenden Lebenszeitprävalenz sowie der persönlichen, sozialen und wirtschaftlichen Belastung durch psychische Störungen muss die Psychiatrie hinsichtlich mehrerer Aspekte ihrer klinischen Ansätze und Forschungsansätze erheblich verändert werden. In den letzten Jahrzehnten hat die Entwicklung der personalisierten Medizin / Präzisionsmedizin in der Psychiatrie, die sich darauf konzentriert, Therapien auf das einzigartige physiologische und genetische Profil jedes Patienten auszurichten, nicht die gleichen Ergebnisse erzielt wie in anderen Bereichen - z. B. der Onkologie. Die lange erwartete Revolution ist bisher nicht eingetroffen. Hierfür gibt es verschiedene Erklärungen, darunter unpräzise diagnostische Kriterien, ein unvollständiges Verständnis der beteiligten molekularen Pathologie, das Fehlen verfügbarer klinischer Hilfsmittel und schließlich die individuellen Charakteristika des Patienten. Seither hat die Koexistenz der beiden Begriffe eine rege Diskussion über die Definition und Unterscheidung zwischen den beiden Arten der Psychiatrie ausgelöst, da sie oft ähnlich oder sogar gleichbedeutend erscheinen. Im Allgemeinen werden die beiden Terminologien innerhalb derselben wissenschaftlichen Arbeiten unterschiedslos, alternativ und / oder getrennt verwendet. Diese Arbeit gibt einen Überblick über die Überschneidung in der Anwendung und Bedeutung der Begriffe ‚Präzisionspsychiatrie’ und ‚personalisierte Psychiatrie’.

Key words

personalized psychiatry - precision psychiatry - personalized medicine - precision medicine - psychiatry

Schlüsselwörter

personalisierte Psychiatrie - Präzisionspsychiatrie - personalisierte Medizin - Präzisionsmedizin - Psychiatrie

Publikationsverlauf

Eingereicht: 29. April 2020

Angenommen: 28. Juni 2020

Artikel online veröffentlicht:
24. August 2020

• Literatur

• 1 Greenhalgh T, Howick J, Maskrey N. Evidence based medicine: a movement in crisis?. BMJ 2014; 348: g3725-g3725. Im Internet: http://www.bmj.com/cgi/doi/10.1136/bmj.g3725
• 2 Sheridan DJ, Julian DG. Achievements and limitations of evidence-based medicine. J Am Coll Cardiol 2016; 68: 204-213. Im Internet: https://linkinghub.elsevier.com/retrieve/pii/S0735109716331370
• 3 Perna G, Nemeroff CB. Personalized medicine in psychiatry: back to the future. Pers Med Psychiatry 2017; 1-2: 1. Im Internet: http://dx.doi.org/10.1016/j.pmip.2017.01.001
• 4 Sugeir S, Naylor S. Critical care and personalized or precision medicine: who needs whom?. J Crit Care 2018; 43: 401-405. Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/29174462
• 5 Personalized Medicine Coalition. The personalized medicine report. Opportunity, challenges, and the future. Pmc 2017: 1-57
• 6 Ziegelstein RC. Personomics: the missing link in the evolution from precision medicine to personalized medicine. J Pers Med 2017 7. AU: Please provide missing page number for the [6] references list entry.
• 7 Redekop WK, Mladsi D. The faces of personalized medicine: a framework for understanding its meaning and scope. Value Heal 2013; 16: S4-S9. Im Internet: https://linkinghub.elsevier.com/retrieve/pii/S1098301513018615
• 8 Christensen CM, Grossman JH, Hwang J. The Innovator’s Prescription. 2009
• 9 National Research Council. Toward precision medicine: building a knowledge network for biomedical research and a new taxonomy of disease. Washington, D.C: National Academies Press; 2011. Im Internet: http://www.nap.edu/catalog/13284
• 10 Secretary OotP. Fact sheet: President Obama’s precision medicine initiative. 2015: 2 Im Internet: https://obamawhitehouse.archives.gov/the-press-office/2015/01/30/fact-sheet-president-obama-s-precision-medicine-initiative
• 11 European Commission. Use of „-omics“ technologies in the development of personalised medicine. SWD(2013) 436 Final 2013; 3: 33. Im Internet: http://ec.europa.eu/health/files/latest_news/2013-10_personalised_medicine_en.pdf
• 12 Perna G, Grassi M, Caldirola D. et al. The revolution of personalized psychiatry: Will technology make it happen sooner?. Psychol Med 2018; 48: 705-713
• 13 Gustavsson A, Svensson M, Jacobi F. et al. CDBE2010Study group. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011; 21: 718-779. Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/21924589
• 14 Perna G, Alciati A, Daccò S. et al. Personalized psychiatry and depression: the role of sociodemographic and clinical variables. Psychiatry Investig 2020; 17: 193-206. Im Internet: http://www.psychiatryinvestigation.org/journal/view.php?doi=10.30773/pi.2019.0289
• 15 World Health Organization - Europe. Mental health and COVID-19. 2020 Im Internet: http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov-technical-guidance/coronavirus-disease-covid-19-outbreak-technical-guidance-europe/mental-health-and-covid-19
• 16 Üstün TB, Ayuso-Mateos JL, Chatterji S. et al. Global burden of depressive disorders in the year 2000. Br J Psychiatry 2004; 184: 386-392
• 17 Manchia M, Carpiniello B. Personalized psychiatry: promises and pitfalls. Neurosci Lett 2018; 669: 1-2. Im Internet: https://linkinghub.elsevier.com/retrieve/pii/S0304394017301775
• 18 Stiefel F, Conus P, Bourquin C. Precision psychiatry: promises made—Promises to be kept?. Aust New Zeal J Psychiatry 2019; 53: 841-843. Im Internet: https://pubmed.ncbi.nlm.nih.gov/31096776
• 19 Zeier Z, Carpenter LL, Kalin NH. et al. Clinical implementation of pharmacogenetic decision support tools for antidepressant drug prescribing. Am J Psychiatry 2018; 175: 873-886
• 20 Faraone SV, Tsuang MT. Measuring diagnostic accuracy in the absence of a „gold standard“. Am J Psychiatry 1994; 151: 650-657
• 21 Aboraya A, Rankin E, France C. et al. The reliability of psychiatric diagnosis revisited: the clinician’s guide to improve the reliability of psychiatric diagnosis. Psychiatry (Edgmont) 2006; 3: 41-50. Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/21103149
• 22 Stephan KE, Bach DR, Fletcher PC. et al. Charting the landscape of priority problems in psychiatry, part 1: classification and diagnosis. Lancet Psychiatry 2016; 3: 77-83. Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/26573970
• 23 Stein DJ, Lund C, Nesse RM. Classification systems in psychiatry: diagnosis and global mental health in the era of DSM-5 and ICD-11. Curr Opin Psychiatry 2013; 26: 493-497
• 24 Stein DJ, Reed GM. Global mental health and psychiatric nosology: DSM-5, ICD-11, and RDoC. Brazilian J Psychiatry 2019; 41: 3-4. Im Internet: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462019000100003&tlng=en
• 25 Culpepper L, Muskin PR, Stahl SM. Major depressive disorder: understanding the significance of residual symptoms and balancing efficacy with tolerability. 2015 Im Internet: http://dx.doi.org/10.1016/j.amjmed.2015.07.001
• 26 Insel TR. The nimh research domain criteria (rdoc) project: precision medicine for psychiatry. Am J Psychiatry 2014; 171: 395-397
• 27 Fried EI, Nesse RM. Depression is not a consistent syndrome: an investigation of unique symptom patterns in the STAR*D study. J Affect Disord 2015; 172: 96-102. Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/25451401
• 28 Orsolini L, Tomasetti C, Valchera A. et al. An update of safety of clinically used atypical antipsychotics. Expert Opin Drug Saf 2016; 15: 1329-1347. Im Internet: https://www.tandfonline.com/doi/full/10.1080/14740338.2016.1201475
• 29 De Berardis D, Rapini G, Olivieri L. et al. Safety of antipsychotics for the treatment of schizophrenia: a focus on the adverse effects of clozapine. Ther Adv Drug Saf 2018; 9: 237-256. Im Internet: http://journals.sagepub.com/doi/10.1177/2042098618756261
• 30 Seyhan AA, Carini C. Are innovation and new technologies in precision medicine paving a new era in patients centric care?. J Transl Med 2019; 17: 114. Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/30953518
• 31 Iniesta R, Hodgson K, Stahl D. et al. Antidepressant drug-specific prediction of depression treatment outcomes from genetic and clinical variables. Sci Rep 2018; 8: 1-9
• 32 Belzung C. Innovative drugs to treat depression: did animal models fail to be predictive or did clinical trials fail to detect effects?. Neuropsychopharmacology 2014; 39: 1041-1051. Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/24345817
• 33 Quinlan EB, Banaschewski T, Barker GJ. et al. Identifying biological markers for improved precision medicine in psychiatry. Mol Psychiatry 2020; 25: 243-253. Im Internet: http://www.nature.com/articles/s41380-019-0555-5
• 34 Perna G, Alciati A, Sangiorgio E. et al. Personalized clinical approaches to anxiety disorders. Adv Exp Med Biol 2020; 1191: 489-521
• 35 Totura CMW, Fields SA, Karver MS. The role of the therapeutic relationship in psychopharmacological treatment outcomes: a meta-analytic review. Psychiatr Serv 2018; 69: 41-47. Im Internet: http://psychiatryonline.org/doi/10.1176/appi.ps.201700114
• 36 Lopez A, Schwenk S, Schneck CD. et al. Technology-based mental health treatment and the impact on the therapeutic alliance. Curr Psychiatry Rep 2019; 21: 76. Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/31286280
• 37 Velligan DI, Sajatovic M, Hatch A. et al. Why do psychiatric patients stop antipsychotic medication? A systematic review of reasons for nonadherence to medication in patients with serious mental illness. Patient Prefer Adherence 2017; 11: 449-468. Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/28424542
• 38 Salagre E, Dodd S, Aedo A. et al. Toward precision psychiatry in bipolar disorder: staging 2.0. Front Psychiatry 2018; 9: 641