What Would It Take to Bring Precision Psychiatry Into Routine Schizophrenia Care?

Clinical uptake of precision psychiatry has lagged behind the sophistication of the research supporting it in schizophrenia, according to panelists at the 2026 Precision Therapeutics for Schizophrenia Symposium.¹ The industry and clinical insights panel, held September 24, 2026, in Roanoke, Virginia, addressed how clinical practice, biomarker development, and drug discovery could be linked more efficiently.

Anita Kablinger, MD, professor and vice chair of research at Carilion Clinic Psychiatry & Behavioral Medicine, first reported noticeable but small changes in her practice over the past 10 to 15 years with precision medicine. Measurement-based care using clinician- and patient-rated scales was the most notable, Kablinger highlighting that it "definitely provides a lot more information than we used to have, and provides some quantitative abilities," although it was not implemented as well. She said she had performed pharmacogenetic testing in 50 to 100 patients annually for the last 6 to 7 years; the results had helped identify unusual medication metabolism but did not indicate which treatment was best.

Kablinger pointed out that access demands in a community-based system often limit systematic quantification of symptom severity and functioning, imaging, and electroencephalography, and electronic health record data are only as good as the information entered. She cited a study in which artificial intelligence transcription captured more mental health symptoms, including depression, yet treatment plans did not change significantly.² Additionally, once new therapies reach the market, clinicians may be slow to adopt them for a variety of reasons; a shortage of research-trained clinicians also remains a barrier because some may avoid trial participation owing to paperwork and regulatory burden, she added. Kablinger also advocated for earlier clinician and patient involvement in research design to avoid burdensome or clinically unimportant measures. She had helped develop research education for Carilion physicians, including a course on clinical trial fundamentals for graduate students, to build that workforce.

Michael Halassa, MD, PhD, of the Fralin Biomedical Research Institute at VTC, followed with reported data from a sequential belief-updating task in which patients rated the plausibility of multiple interpretations across 3 successive statements. Normative trajectories were derived from large language models. Features extracted from patient responses distinguished patients with schizophrenia from healthy controls, correlated with delusion scores on the Positive and Negative Syndrome Scale, and tracked treatment response, including normalization of reasoning trajectories before and after treatment with xanomeline-trospium (Cobenfy).³ Among clinically stable patients, "lower working memory capacity in patients who have a diagnosis of schizophrenia is predictive of psychotic-like reasoning," a pattern that did not appear in healthy controls, according to Halassa. This suggested an interaction between capacity limitations and maladaptive reasoning in psychosis. Interpretable biomarkers, Halassa said, required well-controlled behavioral task design rather than brain measurements alone.

Derek Buhl, PhD, scientific director at AbbVie, said industry biomarker development had to identify patients likely to respond and those susceptible to placebo response, which could undermine a study, without burdening patients or sites. Time constraints precluded complex tasks, so simple, rigorously validated tasks were needed, and validation carried a different meaning for academic scientists than for industry teams answering to regulatory agencies, according to Buhl. He said M4-selective molecules aimed to remove adverse events associated with M1 modulation, predominantly peripheral, while maintaining efficacy in psychosis. Translational animal-model data linking a molecule to neural circuits relevant to behavioral manifestations, such as striatal relative to prefrontal dopamine, supported mechanism selection for early proof-of-concept studies. Buhl noted that the United Kingdom and France had government-funded multisite networks of deeply profiled patients that the United States lacked. A small, dedicated workforce able to deliver data on time, rather than many situations with a single researcher working, is where early partnerships would have the greatest impact, according to Buhl.

Jose Matta, PhD, vice president of discovery at Rapport Therapeutics, said objective biomarkers and pharmacodynamic readouts from academic groups were most valuable for showing that a compound was moving biology in the right direction. Delays arose when expertise and patient throughput were in different countries, requiring multiple phase 1 or phase 2 studies, according to Matta. Contract negotiation is also a barrier; he added that a fee-for-service agreement with timelines, publications, and ownership settled up front moved work fastest, and an academic lab operating as a part-time contract research organization had accelerated a preclinical program.

Closing the gap between precision psychiatry research and routine schizophrenia care depended on earlier collaboration among clinicians, academic investigators, and industry, according to the panelists. Faster agreements, simple validated measures, and a research-trained clinical workforce were identified as practical steps for the field.

Dr Halassa is a professor at the Fralin Biomedical Research Institute at VTC.

Dr Nestor is director of government funding and strategic partnerships at GE HealthCare.

Dr Kablinger is a professor and vice chair of research for Carilion Clinic Psychiatry & Behavioral Medicine.

Dr Buhl is a scientific director at AbbVie.

Dr Matta is vice president of discovery at Rapport Therapeutics.

References

1. Nestor M, Buhl D, Matta J, et al. Industry & clinical insights panel. Presented at: 2026 Precision Therapeutics for Schizophrenia Symposium; September 24, 2026; Fralin Biomedical Research Institute at VTC, Roanoke, VA.

2. Castro VM, McCoy TH, Verhaak P, et al. Psychiatric documentation and management in primary care with artificial intelligence scribe use. JAMA Psychiatry. 2026;83(3):281-286.

3. Kaul I, Sawchak S, Correll CU, et al. Efficacy and safety of the muscarinic receptor agonist KarXT (xanomeline-trospium) in schizophrenia (EMERGENT-2) in the USA: results from a randomised, double-blind, placebo-controlled, flexible-dose phase 3 trial. Lancet. 2024;403(10422):160-170.