Rethinking psychiatry with OMICS science in the age of personalized P5 medicine:ready for psychiatome?

摘要

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is universally acknowledged as the prominent reference textbook for the diagnosis and assessment of psychiatric diseases. However, since the publication of its first version in 1952, controversies have been raised concerning its reliability and validity and the need for other novel clinical tools has emerged. Currently the DSM is in its fourth edition and a new fifth edition is expected for release in 2013, in an intense intellectual debate and in a call for new proposals.Since 1952, psychiatry has undergone many changes and is emerging as unique field in the medical area in which a novel approach is being demanded for properly treating patients: not the classical “one-size-fits-all” approach, but a more targeted and tailored diagnosis and therapeutics, taking into account the complex interactions among genes and their products, environment, culture and the psychological apparatus of the subject.OMICS sciences, being based on high-throughput technologies, are systems biology related fields (like genomics, proteomics, transcriptomics and so on). In the frame of the P5 medicine (personalized, participatory, predictive, preventive, psycho-cognitive), they could establish links between psychiatric diseases, which are disorders with a final common symptomatology with vastly heterogeneous biological, environmental and sociological underpinnings, and by understanding thepsychiatric diseases beyond their classic symptomatic or syndromal definitionsusing OMICS research, one can have a broader picture and unprecedented links andreclassification of psychiatric nosology. Importantly, by understanding the basisof heterogeneity in diseases through OMICS research, one could also personalizetreatment of psychiatric illnesses.In this manuscript, we discuss a gap in the current psychiatric research, namelythe missing logical link among OMICS, personalized medicine and reclassificationof diseases. Moreover, we explore the importance of incorporating OMICS-basedquantitative dimensional criteria, besides the classical qualitative andcategorical approach.