Session to Explore the Progress of Precision Psychiatry

With innovation being one of the core themes of this year’s APA Annual Meeting, it is fitting that there will be a session focusing on a topic expected to play a major role in future psychiatric care: precision psychiatry.

Taking concepts from the broader field of precision medicine, precision psychiatry aims for more individualization in patient care from the moment of diagnosis through treatment.

“In psychiatry, we don’t classify disorders using biological systems the way a field like oncology does,” said session chair Daniel R. Karlin, M.D., the chief medical officer at MindMed, a company developing psychedelic and non-psychedelic psychiatric medicines and digital companion devices. Even in other fields like cardiology, physicians can rely on measurable physiological metrics (for example, stroke volume or blood pressure), whereas psychiatrists make a diagnosis based on phenomenology.

“It’s how patients tell us they feel, and how we think they feel based on clinical observations,” he said. The result are disorders like depression that are highly likely to be biologically heterogenous.

“What precision psychiatry asks is, Can we look at the information which we already have—such as a patient’s medical record and the patient’s behavioral phenomenology—with a finer grain so that we can make more precise diagnoses, ultimately working toward meaningfully incorporating biological information such as genomics?” Karlin said.

This session will discuss the evolution of precision psychiatry, which was conceptualized as a field just recently but has a long tradition, Karlin explained. “If you think back to the early years of psychiatry and psychoanalysis, we had a rich system where doctors focused on what patients said and how they acted to develop robust diagnostic formulations and offer what could be called precision treatment in today’s vernacular—highly individualized psychotherapeutic interventions,” he said.

Today, busy psychiatrists have to be more efficient with their time, but this is where machine learning programs and other digital tools can be helpful. Karlin and his co-presenters will highlight how technology is being used to collect more detailed patient data and discuss how soon some of these tools will be ready for routine use.

“Part of the conversation will involve reigning in the hype,” Karlin said. “We would all love a future where a simple blood test could answer all of our questions, but if not developed with careful attention to clinical meaningfulness, today’s exciting advances in neuroscience or technology ultimately may not improve patient care.”

But progress is being made, Karlin noted. The ability to monitor patients in real time with the help of mobile devices and acquire quantitative data on activity, sleep, and other characteristics could be transformative. “Psychiatry entails much observation, and our ability to observe improves daily.” ■