Promise of Precision Medicine in Psychiatry Nears Reality

BARCELONA, Spain — Innovative approaches and widespread data sharing are essential in psychiatry to improve patient care and deliver on the long-held promise of precision medicine, a leading European expert says.

In a plenary lecture delivered here at the 31st European College of Neuropsychopharmacology (ECNP) Congress, Marion Leboyer, MD, PhD, professor of psychiatry, University of Paris-Est, Créteil, France, called for the creation of a virtual institute to leverage big data and build partnerships to speed the development of novel psychiatric treatments.

She told a packed auditorium that much of the science needed to bring precision medicine to target different subgroups of patients is already in place, but that innovative, disruptive approaches are needed to bring that science to the clinic.

Leboyer delivered the lecture as part of winning the 2018 ECNP Neuropsychopharmacology Award, which was given in recognition of her outstanding achievements in identifying genetic and environmental risk factors in major psychiatric disorders.

The hope is that precision medicine in psychiatry will transform the diagnosis, treatment, and prognosis of patients with severe psychiatric disorders.

“Today, bipolar disorders, depression, schizophrenia, autism spectrum disorders, OCD [obsessive compulsive disorder], and so many more are known to be clearly heterogeneous, to be overlapping, to be progressive, with different stages that we don’t know precisely how to describe, and to be chronic,” she said.

The good news, said Leboyer, is that in addition to clinical data on psychiatric and somatic symptoms, brain imaging, and genetics, “we have tools to enable us to perform deep phenotyping.”

This massive amount of data, she said, can now be analyzed with “big data” or machine learning. It is hoped that algorithms can be created to identify homogeneous subgroups of patients who can be stratified and treated with precise therapeutic strategies.

These could include target-based treatments, such as probiotics, immunomodulators, cell therapy, psychosocial treatments, gene therapy, deep brain stimulation, and vagal nerve stimulation.

“Today, we’re at a stage where we use empirical medicine, and we use one treatment for all, using evidence-based medicine. For example, we use SSRIs [selective serotonin reuptake inhibitors] for major depressive disorder,” said Leboyer.

However, she believes the time for the use of precision medicine in the clinic is not far away and that practitioners will soon be able to administer specific treatments to subgroups of patients with particular biological signatures.

She gave as an example the possibility of using anti-inflammatory treatments for depressed patients who have an inflammatory signature.

In contrast, she believes the availability of personalized medicine, tailored to individual patients, is a long way off.

Thinking Outside the Box

Leboyer believes three values will lead to the implementation of precision medicine in psychiatry — thinking outside the box, sharing, and caring.

She said that daring to think outside the box initially led her to challenge the psychoanalytic theories of autism that were prevalent at the start of her career and to identify genetic pathways that underpin the disease.

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