Alongside the usual questions about how you’re feeling, your work and your relationships, they look at biometric data from your phone about your sleep and speech patterns, examine the results of a blood test or a brain scan and even check your postcode to see whether your neighbourhood has high levels of pollution. An algorithm then compares that information with data from thousands of other people, determines which types of treatment have worked best for people similar to you and uses its findings to suggest a treatment regime. How personalization and psychedelics are revitalizing psychiatry That’s a vision of the future called precision psychiatry.
And it’s a world away from most people’s experiences today. For all the progress that has been made across the medical sciences, psychiatry remains a frustratingly imprecise discipline. Doctors use someone’s symptoms and clinical history to make a diagnosis and prescribe treatments.
But mental-health diagnoses are broad and can be vague — a particular therapy might transform one person’s life, but offer little help to someone else with apparently the same disorder. As a result, people with mental-health conditions often find themselves cycling through treatments and doses, searching, mostly by trial and error, for one that works. To improve things, psychiatrists want to divide broad diagnoses into more useful subgroups and match treatments to individuals using a data-driven approach.
Some researchers are looking at genes and brain circuits; others are turning to data on speech, sleep or social circumstances. Psychiatrists working on The Diagnostic and Statistical Manual of Mental Disorders (DSM), the discipline’s dominant classification system, are even considering how socio-economic, cultural and environmental factors might be incorporated in the future. Why pharma firms are betting billions on psychedelic drugs despite setbacks “I think precision psychiatry is certainly part of the future,” says Tom Insel, a psychiatrist and former director of the US National Institute of Mental Health (NIMH), who now co-directs several mental-health-focused companies.
Advances in genetics, brain imaging and biomarker research for psychiatry have failed to deliver on their promise before, and studies continue to reveal just how heterogeneous many psychiatric disorders are. Psychiatry has been trying to add precision to diagnosis and treatment for decades. In 1980, the third edition of the DSM introduced specific diagnostic criteria for many conditions.
The aim was to boost reliability: a diagnosis of major depression or schizophrenia should mean roughly the same thing for everyone, even when issued by different psychiatrists. But the DSM relies on symptoms to define conditions, and that proxy introduces complexities. The same symptoms appear in many conditions, and one person might have several diagnoses.
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