‘Precision’ or ‘personalized’ psychiatry: different terms – same content?

2020 ◽  
Vol 88 (12) ◽  
pp. 759-766
Author(s):  
Giampaolo Perna ◽  
Francesco Cuniberti ◽  
Silvia Daccò ◽  
Massimiliano Grassi ◽  
Daniela Caldirola
Keyword(s):  
Mental Disorders ◽  
Precision Medicine ◽  
Diagnostic Criteria ◽  
Molecular Pathology ◽  
Economic Burden ◽  
Lifetime Prevalence ◽  
Genetic Profile ◽  
Clinical Tools ◽  
Personalized Psychiatry ◽  
Unique Individual

AbstractDue to the increased lifetime prevalence and personal, social, and economic burden of mental disorders, psychiatry is in need of a significant change in several aspects of its clinical and research approaches. Over the last few decades, the development of personalized / precision medicine in psychiatry focusing on tailored therapies that fit each patient’s unique individual, physiological, and genetic profile has not achieved the same results as those obtained in other branches, such as oncology. The long-awaited revolution has not yet surfaced. There are various explanations for this including imprecise diagnostic criteria, incomplete understanding of the molecular pathology involved, absence of available clinical tools and, finally, the characteristics of the patient. Since then, the co-existence of the two terms has sparked a great deal of discussion around the definition and differentiation between the two types of psychiatry, as they often seem similar or even superimposable. Generally, the two terminologies are used indiscriminately, alternatively, and / or separately, within the same scientific works. In this paper, an overview is provided on the overlap between the application and meaning of the terms ‘precision psychiatry’ and ‘personalized psychiatry’.

scholarly journals Impact of mental illness on in-patient hospital costs for somatic disorders and associated factors

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Michel ◽  
A J Hammami ◽  
K Chevreul
Keyword(s):  
Primary Care ◽  
Health Promotion ◽  
Mental Illness ◽  
Mental Disorders ◽  
Economic Burden ◽  
Mentally Ill ◽  
Hospital Costs ◽  
Healthcare Systems ◽  
Interaction Terms

Abstract Background People suffering from mental disorders are in poorer somatic health that the general population. This is due in part to poor quality of care in primary care settings, which can in turn have a major impact on hospitals and healthcare systems, in particular in terms of costs. Our objective was to assess the economic burden of acute care admissions for somatic diseases in patients with a mental illness compared to other patients and analyse the factors associated with it. Methods An exhaustive study using French hospital discharge databases was carried out between 2009 and 2013. Total acute hospital costs were calculated from the all payer perspective (statutory health insurance, private health insurances and patient out-of pocket payments). A multivariate regression modelled the association between mental illness and hospital costs while adjusting for other explanatory variables, with and without interaction terms. Results 37,458,810 admissions were included in the analysis. 1,163,972 patients (6.54%) were identified as being mentally ill. Mean total hospital costs at five years per patient were €8,114. Costs per mentally ill patient were on average 34% higher than for a non-mentally patient (€10,637 vs. €7,949). A longitudinal analysis of costs showed a widening of the gap between the two groups as time went by, from 1.60% in 2009 to 10.51% in 2013. In the multivariate model, mental disorders were significantly associated with increased costs, and interaction terms found an increased impact of mental illness on costs in deprived patients. Conclusions Improving quality of primary care and health promotion in people with a mental illness both for their own sake and to decrease the economic burden on the healthcare system, is of vital importance. Key messages There is a significant increase in hospital costs for somatic care in patients with a mental illness compared to other patients, in particular in patients who are also deprived. It is necessary to improve primary care and health promotion in mentally ill patients, for their sake and for the sake of healthcare systems.

scholarly journals Molecular Pathology: A Paradigm Shift towards Precision Medicine

2021 ◽  
Keyword(s):  
Precision Medicine ◽  
Human Genome ◽  
Molecular Pathology ◽  
Human Genome Project ◽  
Paradigm Shift ◽  
Disease Diagnosis ◽  
Genome Project ◽  
Early Disease ◽  
P4 Medicine ◽  
Drug Designing

Healthcare system is experiencing a paradigm shift to precision medicine. Genotypic–phenotypic affiliation has been found to be a fundamental percept in biology after the completion of Human Genome project. The first era of precision medicine is now split into groups and subgroups, making it a meaningful strategy concurrently throughout the clinical phases of drug designing and development. It likewise recommends healthcare reshaping that suggests disease perceptivity or remedial treatment. Thus, translational genomics addresses bench to bedside approach to achieve P4 medicine (personalized, predictive, preventive, and participatory), i.e., early disease diagnosis and specifically designed treating plans instead of one size fits all1.

scholarly journals Contrasting Medical and Legal Standards of Evidence: A Precision Medicine Case Study

2016 ◽  
Vol 44 (1) ◽  
pp. 194-204 ◽  
Author(s):  
Gary E. Marchant ◽  
Kathryn Scheckel ◽  
Doug Campos-Outcalt
Keyword(s):  
Precision Medicine ◽  
New Technologies ◽  
Clinical Care ◽  
Large Body ◽  
Standard Of Care ◽  
Genetic Profile ◽  
Legal Standards ◽  
Standards Of Evidence ◽  
The Individual

As the health care system transitions to a precision medicine approach that tailors clinical care to the genetic profile of the individual patient, there is a potential tension between the clinical uptake of new technologies by providers and the legal system's expectation of the standard of care in applying such technologies. We examine this tension by comparing the type of evidence that physicians and courts are likely to rely on in determining a duty to recommend pharmacogenetic testing of patients prescribed the oral anti-coagulant drug warfarin. There is a large body of inconsistent evidence and factors for and against such testing, but physicians and courts are likely to weigh this evidence differently. The potential implications for medical malpractice risk are evaluated and discussed.

Clinical and psychopathological characteristics of sexual dysfunctions and non-psychotic mental disorders in women

2021 ◽  
Vol LIII (2) ◽  
pp. 42-45
Author(s):  
Alexander V. Martusenko ◽  
Elena O. Boyko ◽  
Olga G. Zaitseva
Keyword(s):  
Mental Disorders ◽  
Diagnostic Criteria ◽  
Inpatient Treatment ◽  
International Classification Of Diseases ◽  
Sexual Disorders ◽  
Sexual Dysfunctions ◽  
Second Stage ◽  
The Third ◽  
Classification Of Diseases

Aim. Study of clinical and psychopathological characteristics in women with sexual dysfunctions and mental disorders of the psychotic level. Material and methods. Clinical-psychopathological and sexological methods were used in the work. The results were processed using the licensed program Statistica 10.0 for Windows. At the first stage, 134 women (mean age 43.115.3 years) were examined who had inpatient treatment in the department for persons with non-psychotic mental disorders. At the second stage, the study involved 89 women (mean age 35.212.2 years), who were diagnosed with sexual dysfunctions. Results. Clinical and psychopathological indicators were studied, clinical, psychopathological and sexological analysis of sexual dysfunctions in women with non-psychotic mental disorders was carried out, taking into account the diagnostic criteria of the International Classification of Diseases-10. Three groups of patients were identified: (1) a group of women with sexual dysfunctions caused by non-psychotic mental disorders; (2) a group of patients in whom non-psychotic mental disorders were formed against the background of primary sexual pathology; (3) a group of patients in whom non-psychotic mental disorders accompany sexual dysfunctions. Conclusions. Sexual disorders in the studied groups are characterized by the predominance of libido disorder in the first group and the second group, as well as the predominance of dyspareunia in the third. There were no significant differences in the duration of sexual dysfunctions in the groups, which must be taken into account when choosing therapeutic and rehabilitation measures.

Gender Dysphoria

2018 ◽  
Author(s):  
Lancer Naghdechi ◽  
Atef Bakhoum ◽  
Waguih William IsHak
Keyword(s):  
Mental Disorders ◽  
Diagnostic Criteria ◽  
Gender Stereotypes ◽  
Gender Dysphoria ◽  
Gender Identity Disorder ◽  
Clinical Manifestations ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Sexual Reassignment Surgery

In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), gender dysphoria (GD), previously known as gender identity disorder, is defined as distress or impairment in psychosocial, occupational, educational, or other areas of life due to a perceived disagreement between a person’s assigned gender, natal gender, and the gender currently experienced or expressed for at least 6 months. The DSM-5 mentions that one’s experienced gender may be outside of binary gender stereotypes. Diagnostic criteria are different for GD in children and in adolescents/adults. This review covers the definition, epidemiology, etiology/genetics, clinical manifestations, and studies/tests/treatments related to GD. Tables list the diagnostic criteria for GD and definitions of common terms. This review contains 2 tables and 30 references Key words: DSM-5, gender dysphoria, sexual reassignment surgery

Voyeuristic Disorder

2019 ◽  
pp. 209-216
Author(s):  
J. Paul Fedoroff
Keyword(s):  
Mental Disorders ◽  
Sexual Activity ◽  
Diagnostic Criteria ◽  
Sexual Arousal ◽  
Recent Literature ◽  
International Classification Of Diseases ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Classification Of Diseases

Abstract: Voyeuristic disorder is defined as a condition in which a person experiences persistent (at least 6 months), recurrent, and intense sexual arousal from observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors. The prevalence of true voyeuristic disorder is estimated to be as high as 12% in men and 4% in women. This chapter discusses the Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases diagnostic criteria for voyeuristic disorder, in addition to its diagnosis, treatment, and prognosis. The recent literature on these topics is reviewed.

scholarly journals T153. THE ECONOMIC BURDEN OF MENTAL DISORDERS: A SYSTEMATIC REVIEW

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S289-S289
Author(s):  
Maria Christensen ◽  
Carmen Lim ◽  
Sukanta Saha ◽  
Danielle Cannon ◽  
Finley Presley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Economic Burden ◽  
Economic Cost ◽  
Production Loss ◽  
Comprehensive Overview ◽  
Loss Method ◽  
The Individual ◽  
Key Terms

Abstract Background About a third of the world’s population will develop a mental disorder over their lifetime. Having a mental disorder is a huge burden in health loss and cost for the individual, but also for society because of treatment cost, production loss and caregivers’ cost. The objective of this study is to synthesize the international published literature on the economic burden of mental disorders. Methods Systematic literature searches were conducted in the databases PubMed, Embase, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to 1980 until May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses; (2) diagnosis of at least one mental disorder (3) samples based on the general population; (4) outcome in monetary units. 13,640 publications were screened by their title/abstract and 439 articles were full-text screened by two independent reviewers. 113 articles were included from the systematic searches and 31 articles from snowball searching, giving a total of 144 included articles. Of these, 41 studies had estimates of the economic burden among people with schizophrenia. Results Information about diagnosis, diagnostic criteria, sample size, age, sex, data sources, study perspective, study period, costing approach, cost categories, discount rate and production loss method and cost unit was extracted. The preliminary results show a substantial variety in the used perspective, methodology, costs components and outcomes in the included studies. An online tool is under development enabling the reader to explore the published information on costs by type of mental disorder, subgroups, country, methodology, and study quality. Discussion To the best of our knowledge, this is the first systematic review synthesizing the economic cost of mental disorders worldwide. The paper will provide an important and comprehensive overview over the economic burden of mental disorders, and the output from this review will inform policy-making.

Precision and personalized assessment, diagnosis and treatment in psychiatry

CNS Spectrums ◽  
2020 ◽  
pp. 1-7
Author(s):  
Konstantinos N. Fountoulakis ◽  
Stephen M. Stahl
Keyword(s):  
Precision Medicine ◽  
Legal Framework ◽  
Clinical Predictors ◽  
And Biological Markers ◽  
Definition Of ◽  
Specific Disorders ◽  
Based Medicine ◽  
Personalized Psychiatry ◽  
Radical Shift ◽  
And Personalized Medicine

Abstract “Precision medicine” and “personalized medicine” constitute goals of research since antiquity and this was intensified with the arrival of the “evidence-based medicine.” precision and personalized psychiatry (3P) when achieved will constitute a radical shift in our paradigm and it will be even more transformative than in other fields of medicine. The biggest problems so far are the problematic definition of mental disorder, available treatments seem to concern broad categories rather than specific disorders and finally clinical predictors of treatment response or side effects and biological markers do not exist. Precision and personalized psychiatry like all precision medicine will be a laborious and costly task; thus the partnership of scientists with industry and the commercialization of new methods and technologies will be an important element for success. The development of an appropriate legal framework which will both support development and progress but also will protect the rights and the privacy of patients and their families is essential.

scholarly journals Mental disorders of known aetiology and precision medicine in psychiatry: a promising but neglected alliance

2016 ◽  
Vol 47 (2) ◽  
pp. 193-197 ◽  
Author(s):  
D. Fraguas ◽  
C. M. Díaz-Caneja ◽  
M. W. State ◽  
M. C. O'Donovan ◽  
R. E. Gur ◽  
...  
Keyword(s):  
Personalized Medicine ◽  
Mental Disorders ◽  
Precision Medicine ◽  
Psychiatric Disorders ◽  
Evidence Based Medicine ◽  
Prediction Models ◽  
Deletion Syndrome ◽  
Clinical Approach ◽  
Evidence Based ◽  
Based Medicine

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.

scholarly journals Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China

2006 ◽  
Vol 37 (1) ◽  
pp. 61-71 ◽  
Author(s):  
SING LEE ◽  
ADLEY TSANG ◽  
MING-YUAN ZHANG ◽  
YUE-QIN HUANG ◽  
YAN-LING HE ◽  
...  
Keyword(s):  
Major Depressive Disorder ◽  
Mental Disorders ◽  
Depressive Disorder ◽  
Age Of Onset ◽  
Lifetime Risk ◽  
Lifetime Prevalence ◽  
Major Depressive ◽  
Cross Sectional ◽  
Dsm Iv ◽  
Prospective Longitudinal

Background. This is the first study to examine variation across cohorts in lifetime risk of DSM-IV mental disorders in metropolitan China.Method. Face-to-face household interviews of 2633 adults in Beijing and 2568 adults in Shanghai were conducted from November 2001 to February 2002 using a multi-stage household probability sampling method. The Chinese World Mental Health (WMH) Survey Initiative version of the WHO Composite International Diagnostic Interview (WMH-CIDI) was used for assessment.Results. Lifetime prevalence of any disorder was 13·2%. Alcohol abuse (4·7%), major depressive disorder (3·5%), and specific phobia (2·6%) were the most common disorders. The median age of onset was later for mood (43 years) than anxiety (17 years) and substance use (25 years) disorders. Compared to observed lifetime prevalence, the projected lifetime risk as of age 75 years increased by 106% for major depressive disorder (7·2%), and was uniformly higher for all disorders. Relative odds of any lifetime disorder were 4·7 in the most recent cohorts (ages 18–34) compared to the eldest cohorts (ages [ges ]65).Conclusions. The findings of this cross-sectional study tally with the view that rapid socioeconomic changes may bring about increasing incidence of mental disorders in China. However, prospective longitudinal studies are needed to confirm if the increase is real. Because of the huge size of the Chinese population, any increase in projected lifetime risk of mental disorders represents an enormous increase in the number of affected individuals.

Sign in / Sign up

Export Citation Format

Share Document