Journal
MOLECULAR PSYCHIATRY
Volume 17, Issue 12, Pages 1174-1179Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/mp.2012.105
Keywords
clinical tests; diagnosis; stratified medicine; stratified psychiatry
Funding
- GSK
- MRC [G0701748/1]
- Innovative Medicines Initiative (IMI) grant NEWMEDS [N8 115008]
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London
- Maudsley NHS Foundation Trust
- King's College London
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Patients with mental disorders show many biological abnormalities which distinguish them from normal volunteers; however, few of these have led to tests with clinical utility. Several reasons contribute to this delay: lack of a biological 'gold standard' definition of psychiatric illnesses; a profusion of statistically significant, but minimally differentiating, biological findings; approximate replications' of these findings in a way that neither confirms nor refutes them; and a focus on comparing prototypical patients to healthy controls which generates differentiations with limited clinical applicability. Overcoming these hurdles will require a new approach. Rather than seek biomedical tests that can 'diagnose' DSM-defined disorders, the field should focus on identifying biologically homogenous subtypes that cut across phenotypic diagnosis-thereby sidestepping the issue of a gold standard. To ensure clinical relevance and applicability, the field needs to focus on clinically meaningful differences between relevant clinical populations, rather than hypothesis-rejection versus normal controls. Validating these new biomarker-defined subtypes will require longitudinal studies with standardized measures which can be shared and compared across studies-thereby overcoming the problem of significance chasing and approximate replications. Such biological tests, and the subtypes they define, will provide a natural basis for a 'stratified psychiatry' that will improve clinical outcomes across conventional diagnostic boundaries.
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