title: Toward a Global Roadmap for Precision Medicine in Psychiatry: Challenges and Opportunities.
abstract: Mental disorders represent a major public health burden worldwide. This is likely to rise in the next decade, with the highest increases predicted to occur in low- and middle-income countries. Current psychotropic medication treatment guidelines focus on uniform approaches to the treatment of heterogeneous disorders and achieve only partial therapeutic success. Developing a global precision medicine approach in psychiatry appears attractive, given the value of this approach in other fields of medicine, such as oncology and infectious diseases. In this horizon scanning analysis, we review the salient opportunities and challenges for precision medicine in psychiatry over the next decade. Variants within numerous genes involved in a range of pathways have been implicated in psychotropic drug response and might ultimately be used to guide choice of pharmacotherapy. Multipronged approaches such as multi-omics (genomics, proteomics, metabolomics) analyses and systems diagnostics together with high-throughput sequencing and genotyping technologies hold promise for identifying precise and targeted treatments in mental disorders. To date, however, the vast majority of pharmacogenomics work has been undertaken in high-income countries on a relatively small proportion of the global population, and many other challenges face the field. Opportunities and challenges for establishing a global roadmap for precision medicine in psychiatry are discussed in this article.
authors.affiliation: 1 Department of Psychiatry and Mental Health, University of Cape Town , Cape Town, South Africa .|2 MRC/UCT Human Genetics Research Unit, Division of Human Genetics, University of Cape Town , Cape Town, South Africa .
authors.forename: Shareefa
authors.initials: S
authors.lastname: Dalvie
authors.affiliation: 1 Department of Psychiatry and Mental Health, University of Cape Town , Cape Town, South Africa .|3 Medical Research Council (MRC) Unit on Anxiety and Stress Disorders , Cape Town, South Africa .
authors.forename: Nastassja
authors.initials: N
authors.lastname: Koen
authors.affiliation: 4 Department of Genetics, Stellenbosch University , Tygerberg, South Africa .|5 Department of Psychiatry, Stellenbosch University , Tygerberg, South Africa .
authors.forename: Nathaniel
authors.initials: N
authors.lastname: McGregor
authors.affiliation: 4 Department of Genetics, Stellenbosch University , Tygerberg, South Africa .
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Connell
authors.affiliation: 4 Department of Genetics, Stellenbosch University , Tygerberg, South Africa .
authors.forename: Louise
authors.initials: L
authors.lastname: Warnich
authors.affiliation: 2 MRC/UCT Human Genetics Research Unit, Division of Human Genetics, University of Cape Town , Cape Town, South Africa .
authors.forename: Raj
authors.initials: R
authors.lastname: Ramesar
authors.affiliation: 6 Department of Psychiatry, University of California San Diego , San Diego, California.|7 Veteran Affairs (VA) San Diego Center of Excellence for Stress and Mental Health , San Diego, California.
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Nievergelt
authors.affiliation: 1 Department of Psychiatry and Mental Health, University of Cape Town , Cape Town, South Africa .|3 Medical Research Council (MRC) Unit on Anxiety and Stress Disorders , Cape Town, South Africa .
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
mesh_terms: D055106:Genome-Wide Association Study; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy* / Q000235:genetics; D010597:Pharmacogenetics; D057285:Precision Medicine; D011570:Psychiatry / Q000639:trends*; D011619:Psychotropic Drugs / Q000627:therapeutic use*
chemical_list: D011619:Psychotropic Drugs