Biomarkers, Personalized Medicine, and Schizophrenia

May 16, 2016

The personalized medicine approach is predicated upon a greater understanding of the biology of illness and how it plays out-uniquely and specifically-for each individual patient.

Psychiatric Times has posed 3 questions to Dr Peter F. Buckley, a psychiatrist and expert on schizophrenia. He will be speaking on “Reliable Biomarkers, Personalized Medicine, and the Treatment of Schizophrenia: Will Science (Ever?) Trump Clinical Trial and Error?” at APA 2016 on Tuesday, May 17 at 9:00 AM.

Q: What is “personalized medicine”?

Peter Buckley (PB): Personalized medicine is a term now ever increasingly used to describe the evolution of medicine in being able to individualize and/or tailor our treatments in a targeted, individualized way for each patient. This approach is predicated upon a greater understanding of the biology of illness and how it plays out-uniquely and specifically-for each individual patient. Other terms that are considered relatively synonymous with personalized medicine include precision medicine and preventative medicine.

Q: How does psychiatry fare compared with other areas of medicine with respect to personalized medicine?

PB: In many ways, cancer research and clinical care is leading the way in advancing personalized medicine. The genetic risk-and treatment sensitivity-of several cancers is now better known. For example, whether a female with breast cancer possesses the BRCA gene now powerfully determines which drugs should be selected to tailor care to her. Another example is the selection and dosing of anticoagulant medications based upon the genetic makeup of the patient as it relates to the slow or fast metabolism of these drugs.

Continued advances in our understanding of mental illnesses as well as the development and validation of biomarkers could be a game changer.

In psychiatry, we are also advancing these approaches. We are now aware, due to the work of Dr Charles Nemeroff and many others, that genetic susceptibility to stress powerfully contributes to whether people develop depression when exposed to life stressors during adulthood.1 In another exciting initiative, Dr Carol Tamminga and colleagues2 have conducted a comprehensive study of the neurobiology (or “neurobiologies”) of psychoses-across schizophrenia, schizoaffective disorder, and bipolar disorder.

[[{"type":"media","view_mode":"media_crop","fid":"45724","attributes":{"alt":"schizophrenia","class":"media-image","id":"media_crop_1489146643962","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5798","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"width: 176px; height: 176px; float: right","title":"©Lightspring/Shutterstock","typeof":"foaf:Image"}}]]Interestingly, our colleagues have found 3 distinct “biotypes”-that is, neurobiologically-defined patient groups, as opposed to the more “traditional” distinctions of psychosis as schizophrenia, schizoaffective disorder, and mood disorder.3 Exciting stuff. Several other groups across the US and globally are working on similar approaches.

There’s also a lot of emphasis on developing and validating biomarkers for mental illnesses. Our field is grateful to Dr Thomas Insel, immediate past director of the NIMH for his strategic leadership in advancing us toward personalized medicine.

Q: What might mental health care look like in 5 years?

PB: Well, like all other areas of medicine, the extent to which healthcare reform will be fully implemented will powerfully influence how mental healthcare will be delivered. The increased insurance coverage is already a major accomplishment and of course people with mental illness and/or addiction problems are also represented in this success. The extent to which the implementation of healthcare reform will truly encompass mental health parity will also be another key determinant. Furthermore, psychiatry will need to embrace value-based reimbursement and, in doing so, agree upon and promulgate quality metrics that are appropriate for the major mental health conditions.

Finally, continued advances in our understanding of mental illnesses as well as the development and validation of biomarkers could be a game changer for early identification, assessment, and targeted treatments for mental illnesses. Collectively, these are great opportunities for psychiatry and will shape where and how we deliver mental health care into the future. Time will tell.

Disclosures:

Dr Buckley is the Dean of the Medical College of Georgia at Augusta University, Augusta, Georgia, and a member of the Psychiatric Times Editorial Board.

References:

1. Nemeroff CB. Paradise lost: the neurobiological and clinical consequences of child abuse and neglect. Neuron. 2016;89:892-909.
2. .Clementz BA, Sweeney JA, Hamm JP, et al. Identification of distinct psychosis bio types using brain based bio markers. Am J Psychiatry. 2016;173:373-384.
3. De Leon J. Is psychiatry only neurology? Or only abnormal psychology? Deja Vu after 100 years. Act Neuropsychiatry. 2015;27:69-81.