Personalized Mental Healthcare: Promise and ConvergenceFollowing on the announcement of the human genome sequence in the summer of 2000, at the dizzying height of internet mania, a new era of medicine was proclaimed: one where the identification of specific genes and biomarkers that predispose individuals to illness will give physicians predictive and personalized tools for the early intervention and treatment of illness.
John A. Fossella, PhD MBA
Medical Progress Today
May 11, 2007
Seven years later, these early predictions are coming to fruition. Combined with advances in information technology, consumers in this new era will increasingly be empowered to control their medical privacy and to choose rationally among healthcare providers and financing plans. New personalized medicines, including Herceptin®, Gleevec® and Tarceva®, and personal healthcare management tools, such as WebMD and Revolution Health, provide a glimpse of consumer–driven health care wedded to personalized medicine.
But what can this new personalized era offer a child or adult beset with a disabling cognitive impairment or emotional distress? How might a consumer who experiences mental or emotional difficulties obtain and manage the diagnosis, financing, privacy and the course of their care in a self–directed way?
Costs of Mental Illness
Because mental illness so often disrupts a person's ability to think clearly, seek assistance, and cope with stress, adults and children with mental and brain developmental disabilities are often among the most disadvantaged and vulnerable members of society. According to the Surgeon General, some 15 percent of the population will seek mental health services for temporary assistance and treatment for diagnosed disorders, placing mental disability as the 2nd most serious source of disability-adjusted life year losses (DALY).
Adding to the urgency is a swell of retirees prone to age–related mental illness such as Alzheimer's Disease and Parkinson's Disease, poised to demand more mental health services. With aggregate direct and indirect costs of mental disorders currently in the neighborhood of $100 billion, there is ample human and financial need to gauge the possible benefits of an emerging biomarker and consumer–driven era of personalized medicine.
Linking the Genome with IT
There is great optimism in the field thanks to a synergy of genomic–level clinical research and IT platforms that allow open–access to this information and other types of information related to healthcare, such as hospital and doctor ratings and personal health risk-management tools. Some more recent legal and policy reforms—including HIPAA, the Mental Health Parity Act, the Genetic Information Nondiscrimination Act, FDA pharmacogenetics guidance and the creation of Health Savings Accounts—also do much to facilitate this emerging era.
In the field of mental healthcare, much of the promise of personalized medicine in psychiatry derives from the technological advances in brain imaging and pharmacotherapy. The past 10 years have witnessed tremendous insight into the activity of the normal and abnormal developing brain, such that deficits in the structure and function of specific brain areas, like the prefrontal cortex, anterior cingulate cortex and amygdala, have been related to disabling illnesses such as schizophrenia and depression.
Brain Imaging, Genetics, and Therapy Solution
More recently, genomic analyses have been synthesized with brain imaging studies so that physicians and researchers might understand how genetic biomarkers that predispose individuals to mental illness can affect brain structure and function. For example, the gene for the serotonin transporter (5HTT) has for many years been shown to contribute to risk for anxiety disorders. The protein encoded by the 5HTT gene is the target of a class of effective antidepressant compounds known as selective serotonin reuptake inhibitors(SSRIs).
In 2002, the first link between variation in the 5HTT gene and brain activity was found to occur in a brain region known as the amygdala, where emotional memories are stored and relayed. Individuals who carry a type of 5HTT genetic predisposition for anxiety were found to have a more active amygdala when viewing stimuli designed to illicit emotional responses. Thus, a complete synthesis between brain activity, genetic variation and pharmacotherapy has been accomplished, and it is now possible to view the effects of drug treatment through brain imaging. The implications are far reaching, but at face level, serve to match a certain biological process to more effective treatment options.
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