Despite the tremendous advances in psychiatry in recent years, the current clinical practice of psychiatry continues to rely on data from intermittent assessments along with subjective and unquantifiable accounts from patients and caregivers. Furthermore, there continues to be significant diagnostic variations among practitioners. Fortunately, technology to address these issues appears to be on the horizon.
How might the psychiatric clinic of the future look? What changes could we envision? These 4 critical factors may soon bring about dynamic changes in the way we practice psychiatry:
- precision psychiatry
- digital psychiatry
- technology-enhanced psychotherapy
- electronic health record (EHR) reforms.
In this article, we review how advances in each of these areas might lead to improved care for our patients.
Precision psychiatry takes into account each patient’s variability in genes, environment, and lifestyle to determine individualized treatment and prevention strategies. It relies on pharmacogenomic testing as the primary tool. Pharmacogenomics is the study of variability in drug response due to heredity.
Emerging data on the clinical utility and cost-effectiveness of pharmacogenomic testing are encouraging, but its routine use is not well supported by current evidence.2 One limit to using pharmacogenomic testing is that many genes simultaneously exert an effect on the structure and function of neurons and associated pathophysiology. According to the International Society of Psychiatric Genetics, no single genetic variant is sufficient to cause psychiatric disorders such as depression, bipolar disorder, substance dependence, or schizophrenia. This limits the possibility of using genetic tests to establish a diagnosis.3
In the future, better algorithms could promote more accurate pharmacogenomics profiles for individual patients, which could influence treatment.
Precision psychiatry could lead to:
- identification of novel targets for new medications
- pharmacogenetic profiling of the patient to predict disease susceptibility and medication response
- personalized therapy: the right drug at the right dose for the right patient.
- improved efficacy and fewer adverse medication reactions.
Continue to: Digital psychiatry