Gauld C, Micoulaud-Franchi J-A
Centre Hospitalier universitaire Saint-Étienne, service universitaire de psychiatrie, hôpital Bellevue, 25, boulevard Pasteur, 42000 Saint-Étienne, France.
Services d'explorations fonctionnelles du système nerveux, clinique du sommeil, CHU de Bordeaux, Place Amélie Raba-Leon, 33076 Bordeaux, France; USR CNRS 3413 SANPSY, CHU Pellegrin, université de Bordeaux, BordeauxFrance.
Encephale. 2021 Aug;47(4):341-347. doi: 10.1016/j.encep.2020.08.008. Epub 2020 Nov 12.
The current challenges of psychiatric nosology and semiology are part of an interdisciplinary and integrative framework. The paradigm of the personalized and precision psychiatry proposes to study this discipline according to new approaches and methodologies. Personalized and precision psychiatry therefore requires clarification of its concepts. To our knowledge, there is no systematic exploration of the literature on the application of the concepts of personalized and precision medicine in the field of psychiatry. This article proposes thus to explore the framework of personalized and precision medicine applied to psychiatry.
We explored the framework of personalized and precision medicine applied to psychiatry by a textual network analysis. Firstly, we performed a systematic text-mining (Natural Language Processing) from an exhaustive review of the international literature with the terms "precision psychiatry" and "personalized psychiatry". Secondly, this analysis of textual data allowed us to build a textual network which made it possible to visualize the most proximal terms (the most frequently associated in the literature). Finally, we extracted from the network the main dimensions explored in the scientific literature, and we studied the relative importance of each term by analyzing the network centrality. In addition, a brief bibliometric analysis was conducted.
We show that personalized and precision psychiatry refers to six dimensions found in the textual network analysis which correspond to the scientific fields which study personalized and precision psychiatry: genetics, pharmacogenetics, artificial intelligence, therapeutic trials, biomarkers and staging. We explore how each dimension relates to the mechanization of psychiatric disorders. However, precision and personalized psychiatry, which tries to refine the levels of mechanistic explanations for psychiatry, suffers from a conceptual heterogeneity. Indeed, textual analysis also allows us to find terms referring to a set of heterogeneous concepts. Many methodological fields and epistemological concepts are invoked in this literature, without standardization.
The paradox of personalized and precision psychiatry is to associate a strong conceptual heterogeneity with a well-defined mechanistic component. Heterogeneity found in literature on personalized and precision psychiatry testifies to the lack of a pluralist and integrative theoretical framework. This framework could be based on a naturalizing but non-reducing formalism, aware of the societal challenges of the sciences and their implementation in the research and clinical systems of psychiatry.
精神疾病分类学和症状学当前面临的挑战是跨学科综合框架的一部分。个性化与精准精神病学范式提议依据新的方法和手段来研究这一学科。因此，个性化与精准精神病学需要对其概念进行阐释。据我们所知，目前尚无对个性化与精准医学概念在精神病学领域应用的文献进行系统探究。本文旨在探讨应用于精神病学的个性化与精准医学框架。
我们通过文本网络分析来探究应用于精神病学的个性化与精准医学框架。首先，我们对国际文献进行详尽回顾，使用“精准精神病学”和“个性化精神病学”等术语进行系统的文本挖掘（自然语言处理）。其次，对文本数据的分析使我们构建了一个文本网络，借此能够可视化最相近的术语（文献中关联最频繁的术语）。最后，我们从网络中提取科学文献所探究的主要维度，并通过分析网络中心性来研究每个术语的相对重要性。此外，还进行了简要的文献计量分析。
我们发现，个性化与精准精神病学在文本网络分析中涉及六个维度，这些维度对应于研究个性化与精准精神病学的科学领域：遗传学、药物遗传学、人工智能、治疗试验、生物标志物和疾病分期。我们探讨了每个维度与精神疾病机制的关联。然而，试图细化精神病学机制解释水平的精准与个性化精神病学存在概念异质性问题。事实上，文本分析还使我们发现了涉及一组异质概念的术语。该文献中援引了许多方法学领域和认识论概念，但缺乏标准化。
个性化与精准精神病学的矛盾之处在于，其概念异质性强，而机制组成部分却定义明确。个性化与精准精神病学文献中的异质性表明缺乏多元且综合的理论框架。这个框架可以基于一种自然化但非还原的形式主义，同时意识到科学面临的社会挑战及其在精神病学研究和临床系统中的应用。
