Title: "Precision psychiatry: what will it take?”
Speaker: Steven Hyman, MD
Director, Stanley Center for Psychiatric Research
Broad Institute of MIT and Harvard
Description: If psychiatry is to develop mechanism-based treatments that can be administered to appropriately matched patients, the necessary first step is to jettison the current disease classification, a pervasive source of confounding, and start afresh. I argue that the most feasible approach to etiology and mechanism-based diagnoses in psychiatry begins with a retreat from the nearly 300 discontinuous disorder categories posited with a scant evidentiary basis by the DSM-5 to a small number of broad, empirically defensible spectra. These could be based on symptom and syndrome covariation (phenomenology) but reanalyzed in light of emerging genetics. Beginning spectra might include a schizophrenia (or psychosis) spectrum; internalizing disorders (including depression and anxiety disorders); and externalizing disorders (such as ADHD and impulse control disorders). The goal would be to stratify patients within these spectra in a data-driven manner that will require continued advances in human genetics, human neurobiology (e.g., single cell analyses of postmortem human brains), and biomarkers research. For brain disorders, patient stratification using fluid and imaging biomarkers, along with genetics, is already used in some clinical trials for neurodegerative disorders. This approach can serve as a heuristic to guide progress in neuropsychiatric disorders. I will illustrate early results in psychiatry recognizing that precision psychiatry remains a distant aspiration—albeit now faintly visible on the horizon.
This event is hosted as part of the seminar series featuring leaders in precision medicine from across the nation. Co-presented by the Center for Precision Medicine and Genomics, the Columbia Precision Medicine Initiative, and the Precision Medicine Resource of the Irving Institute for Clinical and Translational Research. This event is supported in part by a gift from Pfizer to Columbia.
