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从精准心理健康角度看抑郁症:利用个性化概念化来指导个性化治疗。

Depression From a Precision Mental Health Perspective: Utilizing Personalized Conceptualizations to Guide Personalized Treatments.

作者信息

Deif Reem, Salama Mohamed

机构信息

Institute of Global Health and Human Ecology, School of Sciences and Engineering, The American University in Cairo, Cairo, Egypt.

Faculty of Medicine, Mansoura University, Mansoura, Egypt.

出版信息

Front Psychiatry. 2021 May 11;12:650318. doi: 10.3389/fpsyt.2021.650318. eCollection 2021.

Abstract

Modern research has proven that the "typical patient" requiring standardized treatments does not exist, reflecting the need for more personalized approaches for managing individual clinical profiles rather than broad diagnoses. In this regard, precision psychiatry has emerged focusing on enhancing prevention, diagnosis, and treatment of psychiatric disorders through identifying clinical subgroups, suggesting personalized evidence-based interventions, assessing the effectiveness of different interventions, and identifying risk and protective factors for remission, relapse, and vulnerability. Literature shows that recent advances in the field of precision psychiatry are rapidly becoming more data-driven reflecting both the significance and the continuous need for translational research in mental health. Different etiologies underlying depression have been theorized and some factors have been identified including neural circuitry, biotypes, biopsychosocial markers, genetics, and metabolomics which have shown to explain individual differences in pathology and response to treatment. Although the precision approach may prove to enhance diagnosis and treatment decisions, major challenges are hindering its clinical translation. These include the clinical diversity of psychiatric disorders, the technical complexity and costs of multiomics data, and the need for specialized training in precision health for healthcare staff, besides ethical concerns such as protecting the privacy and security of patients' data and maintaining health equity. The aim of this review is to provide an overview of recent findings in the conceptualization and treatment of depression from a precision mental health perspective and to discuss potential challenges and future directions in the application of precision psychiatry for the treatment of depression.

摘要

现代研究已经证明,需要标准化治疗的“典型患者”并不存在,这反映出需要采用更个性化的方法来管理个体临床特征,而不是宽泛的诊断。在这方面,精准精神病学应运而生,它专注于通过识别临床亚组、提出基于证据的个性化干预措施、评估不同干预措施的有效性以及识别缓解、复发和易感性的风险和保护因素,来加强精神疾病的预防、诊断和治疗。文献表明,精准精神病学领域的最新进展正迅速变得更加以数据为驱动,这既反映了心理健康转化研究的重要性,也反映了其持续需求。抑郁症的不同病因已经得到理论阐述,并且已经确定了一些因素,包括神经回路、生物类型、生物心理社会标志物、遗传学和代谢组学,这些因素已被证明可以解释病理和治疗反应方面的个体差异。尽管精准方法可能会提高诊断和治疗决策水平,但一些重大挑战阻碍了其临床转化。这些挑战包括精神疾病的临床多样性、多组学数据的技术复杂性和成本,以及医护人员需要接受精准健康方面的专业培训,此外还有伦理问题,如保护患者数据的隐私和安全以及维护健康公平。本综述的目的是从精准心理健康的角度概述抑郁症概念化和治疗方面的最新研究结果,并讨论精准精神病学在抑郁症治疗应用中的潜在挑战和未来方向。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5173/8144285/ce920103fb0a/fpsyt-12-650318-g0002.jpg

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