Češková Eva
Cas Lek Cesk. 2019 Winter;158(7-8):328-331.
Currently, patients are evaluated by a psychiatrist using the phenomenological classification then, first-line treatment is initiated according to the diagnosis; however, this approach is associated with a high rate of etiopathogenetic heterogeneity. The development of mental disorders is likely determined by combined effects of genetic predisposition and environmental adversity. Inter-mutual interaction is regulated by epigenetics processes which determine transcription and translation of gens to corresponding proteins. Choosing the optimal drug among available we strive for individualized approach based upon a patient's clinical characteristics. Personalized medicine including psychiatry considers measurable indicators of pathogenic processes (biomarkers) enabling identification of patients with common biological changes. Although personalized and precision medicine are often used synonymously, they describe two different approaches. Personalized psychiatry refers to the approach to an individual patient, precision psychiatry empowers decision- making process by measurable indicators and becomes the indispensable vehicle to achieve personalized treatment. An example is schizophrenia, the most severe mental disorder and prototype of psychotic disorder. The current definition of schizophrenia lacks a biological validity, which is stimulating an effort to alternatively define the psychotic disorders on the base of biomarkers. The goal of integration knowledge from biomedical research and clinical practice is providing more accurate diagnosis and the tailored treatment for each individual patient.
目前,精神科医生会根据现象学分类对患者进行评估,然后根据诊断开始一线治疗;然而,这种方法存在较高的病因发病机制异质性。精神障碍的发展可能由遗传易感性和环境逆境的综合作用决定。相互作用由表观遗传过程调节,表观遗传过程决定基因转录和翻译成相应蛋白质。在可用药物中选择最佳药物时,我们力求根据患者的临床特征采取个体化方法。包括精神病学在内的个性化医学考虑致病过程的可测量指标(生物标志物),从而能够识别具有共同生物学变化的患者。尽管个性化医学和精准医学常常被视为同义词,但它们描述的是两种不同的方法。个性化精神病学指的是针对个体患者的方法,精准精神病学通过可测量指标增强决策过程,成为实现个性化治疗不可或缺的手段。精神分裂症就是一个例子,它是最严重的精神障碍,也是精神障碍的典型代表。目前精神分裂症的定义缺乏生物学有效性,这促使人们努力基于生物标志物重新定义精神障碍。整合生物医学研究和临床实践知识的目标是为每个患者提供更准确的诊断和量身定制的治疗。