title: Biomarkers and clinical staging in psychiatry.
abstract: Personalized medicine is rapidly becoming a reality in today's physical medicine. However, as yet this is largely an aspirational goal in psychiatry, despite significant advances in our understanding of the biochemical, genetic and neurobiological processes underlying major mental disorders. Preventive medicine relies on the availability of predictive tools; in psychiatry we still largely lack these. Furthermore, our current diagnostic systems, with their focus on well-established, largely chronic illness, do not support a pre-emptive, let alone a preventive, approach, since it is during the early stages of a disorder that interventions have the potential to offer the greatest benefit. Here, we present a clinical staging model for severe mental disorders and discuss examples of biological markers that have already undergone some systematic evaluation and that could be integrated into such a framework. The advantage of this model is that it explicitly considers the evolution of psychopathology during the development of a mental illness and emphasizes that progression of illness is by no means inevitable, but can be altered by providing appropriate interventions that target individual modifiable risk and protective factors. The specific goals of therapeutic intervention are therefore broadened to include the prevention of illness onset or progression, and to minimize the risk of harm associated with more complex treatment regimens. The staging model also facilitates the integration of new data on the biological, social and environmental factors that influence mental illness into our clinical and diagnostic infrastructure, which will provide a major step forward in the development of a truly pre-emptive psychiatry.
authors.affiliation: Orygen Youth Health Research Centre, Centre for Youth Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: McGorry
authors.forename: Matcheri
authors.initials: M
authors.lastname: Keshavan
authors.forename: Sherilyn
authors.initials: S
authors.lastname: Goldstone
authors.forename: Paul
authors.initials: P
authors.lastname: Amminger
authors.forename: Kelly
authors.initials: K
authors.lastname: Allott
authors.forename: Michael
authors.initials: M
authors.lastname: Berk
authors.forename: Suzie
authors.initials: S
authors.lastname: Lavoie
authors.forename: Christos
authors.initials: C
authors.lastname: Pantelis
authors.forename: Alison
authors.initials: A
authors.lastname: Yung
authors.forename: Stephen
authors.initials: S
authors.lastname: Wood
authors.forename: Ian
authors.initials: I
authors.lastname: Hickie
keywords: Biomarkers; clinical staging; diagnostic reform; early intervention; personalized medicine; pre-emptive psychiatry; youth mental health