title: Mental disorders of known aetiology and precision medicine in psychiatry: a promising but neglected alliance.
abstract: Personalized or precision medicine is predicated on the assumption that the average response to treatment is not necessarily representative of the response of each individual. A commitment to personalized medicine demands an effort to bring evidence-based medicine and personalized medicine closer together. The use of relatively homogeneous groups, defined using a priori criteria, may constitute a promising initial step for developing more accurate risk-prediction models with which to advance the development of personalized evidence-based medicine approaches to heterogeneous syndromes such as schizophrenia. However, this can lead to a paradoxical situation in the field of psychiatry. Since there has been a tendency to loosely define psychiatric disorders as ones without a known aetiology, the discovery of an aetiology for psychiatric syndromes (e.g. 22q11.2 deletion syndrome in some cases of schizophrenia), while offering a path toward more precise treatments, may also lead to their reclassification away from psychiatry. We contend that psychiatric disorders with a known aetiology should not be removed from the field of psychiatry. This knowledge should be used instead to guide treatment, inasmuch as psychotherapies, pharmacotherapies and other treatments can all be valid approaches to mental disorders. The translation of the personalized clinical approach inherent to psychiatry into evidence-based precision medicine can lead to the development of novel treatment options for mental disorders and improve outcomes.
authors.affiliation: Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón,CIBERSAM,IiSGM, School of Medicine,Universidad Complutense de Madrid,Madrid,Spain.
authors.forename: D
authors.initials: D
authors.lastname: Fraguas
authors.affiliation: Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón,CIBERSAM,IiSGM, School of Medicine,Universidad Complutense de Madrid,Madrid,Spain.
authors.forename: C M
authors.initials: CM
authors.lastname: Díaz-Caneja
authors.affiliation: Department of Psychiatry and Langley Porter Psychiatric Institute,University of California,San Francisco,CA,USA.
authors.forename: M W
authors.initials: MW
authors.lastname: State
authors.affiliation: Department of Psychological Medicine and Clinical Neuroscience,MRC Centre for Neuropsychiatric Genetics and Genomics,Cardiff University School of Medicine,Heath Park,Cardiff,UK.
authors.forename: M C
authors.initials: MC
authors.lastname: O'Donovan
authors.affiliation: Department of Psychiatry,Neuropsychiatry Section,Perelman School of Medicine,University of Pennsylvania,Philadelphia,PA,USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Gur
authors.affiliation: Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón,CIBERSAM,IiSGM, School of Medicine,Universidad Complutense de Madrid,Madrid,Spain.
authors.forename: C
authors.initials: C
authors.lastname: Arango
mesh_terms: D006801:Humans; D001523:Mental Disorders / Q000209:etiology / Q000628:therapy*; D057285:Precision Medicine / Q000379:methods / Q000592:standards*; D011570:Psychiatry / Q000379:methods / Q000592:standards*
keywords: 22q11.2 deletion syndrome; Personalized medicine; psychiatry; risk-prediction models; schizophrenia