1
|
Gómez-Carrillo A, Paquin V, Dumas G, Kirmayer LJ. Restoring the missing person to personalized medicine and precision psychiatry. Front Neurosci 2023; 17:1041433. [PMID: 36845417 PMCID: PMC9947537 DOI: 10.3389/fnins.2023.1041433] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/09/2023] [Indexed: 02/11/2023] Open
Abstract
Precision psychiatry has emerged as part of the shift to personalized medicine and builds on frameworks such as the U.S. National Institute of Mental Health Research Domain Criteria (RDoC), multilevel biological "omics" data and, most recently, computational psychiatry. The shift is prompted by the realization that a one-size-fits all approach is inadequate to guide clinical care because people differ in ways that are not captured by broad diagnostic categories. One of the first steps in developing this personalized approach to treatment was the use of genetic markers to guide pharmacotherapeutics based on predictions of pharmacological response or non-response, and the potential risk of adverse drug reactions. Advances in technology have made a greater degree of specificity or precision potentially more attainable. To date, however, the search for precision has largely focused on biological parameters. Psychiatric disorders involve multi-level dynamics that require measures of phenomenological, psychological, behavioral, social structural, and cultural dimensions. This points to the need to develop more fine-grained analyses of experience, self-construal, illness narratives, interpersonal interactional dynamics, and social contexts and determinants of health. In this paper, we review the limitations of precision psychiatry arguing that it cannot reach its goal if it does not include core elements of the processes that give rise to psychopathological states, which include the agency and experience of the person. Drawing from contemporary systems biology, social epidemiology, developmental psychology, and cognitive science, we propose a cultural-ecosocial approach to integrating precision psychiatry with person-centered care.
Collapse
Affiliation(s)
- Ana Gómez-Carrillo
- Culture, Mind, and Brain Program, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Vincent Paquin
- Culture, Mind, and Brain Program, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Guillaume Dumas
- Culture, Mind, and Brain Program, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC, Canada
- Precision Psychiatry and Social Physiology Laboratory at the CHU Sainte-Justine Research Center, Université de Montréal, Montreal, QC, Canada
- Mila-Quebec Artificial Intelligence Institute, Montreal, QC, Canada
| | - Laurence J Kirmayer
- Culture, Mind, and Brain Program, Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill University, Montreal, QC, Canada
- Culture and Mental Health Research Unit, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
| |
Collapse
|
2
|
Affiliation(s)
- Eduard Vieta
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 08036, Barcelona, Catalonia, Spain
| | - Estela Salagre
- Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 08036, Barcelona, Catalonia, Spain
| |
Collapse
|