Biomarkers and clinical staging in psychiatry
Biomarkers and clinical staging in psychiatry
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DOI：
10.1002/wps.20144
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发表时间：
2014-10-01
期刊：
影响因子：
73.3
通讯作者：
Hickie, Ian
中科院分区：
文献类型：
--
作者：
McGorry, Patrick;Keshavan, Matcheri;Hickie, Ian
个性化医疗正在迅速成为现实，在今天的物理医学。然而，尽管我们对主要精神障碍的生化、遗传和神经生物学过程的理解取得了重大进展，但这在很大程度上仍是精神病学的一个理想目标。预防医学依赖于预测工具的可用性;在精神病学中，我们仍然很大程度上缺乏这些工具。此外，我们目前的诊断系统，其重点是完善的，主要是慢性疾病，不支持先发制人，更不用说预防性的方法，因为它是在一个疾病的早期阶段，干预措施有可能提供最大的好处。在这里，我们提出了一个严重精神障碍的临床分期模型，并讨论了生物标志物的例子，已经经历了一些系统的评估，可以整合到这样一个框架。这种模式的优点是，它明确考虑了精神疾病发展过程中的精神病理学演变，并强调疾病的进展绝非不可避免，而是可以通过提供针对个人可改变的风险和保护因素的适当干预措施来改变。因此，治疗干预的具体目标扩大到包括预防疾病发作或进展，并尽量减少与更复杂的治疗方案相关的伤害风险。分期模型还有助于将影响精神疾病的生物、社会和环境因素的新数据整合到我们的临床和诊断基础设施中，这将为发展真正的先发制人的精神病学迈出重要一步。
Personalized medicine is rapidly becoming a reality in today's physical medicine. However, as yet this is largely an aspirational goal in psychiatry, despite significant advances in our understanding of the biochemical, genetic and neurobiological processes underlying major mental disorders. Preventive medicine relies on the availability of predictive tools; in psychiatry we still largely lack these. Furthermore, our current diagnostic systems, with their focus on well-established, largely chronic illness, do not support a pre-emptive, let alone a preventive, approach, since it is during the early stages of a disorder that interventions have the potential to offer the greatest benefit. Here, we present a clinical staging model for severe mental disorders and discuss examples of biological markers that have already undergone some systematic evaluation and that could be integrated into such a framework. The advantage of this model is that it explicitly considers the evolution of psychopathology during the development of a mental illness and emphasizes that progression of illness is by no means inevitable, but can be altered by providing appropriate interventions that target individual modifiable risk and protective factors. The specific goals of therapeutic intervention are therefore broadened to include the prevention of illness onset or progression, and to minimize the risk of harm associated with more complex treatment regimens. The staging model also facilitates the integration of new data on the biological, social and environmental factors that influence mental illness into our clinical and diagnostic infrastructure, which will provide a major step forward in the development of a truly pre-emptive psychiatry.