Mental disorders represent a huge public health challenge. The high morbidity and mortality figures speak to the potential for overall health gains if mental disorders can be more effectively diagnosed and treated. Insel and Cuthbert ask whether a “precision medicine” approach could be useful here. The approach is to integrate clinical data with other patient information to uncover disease subtypes and improve the accuracy with which patients are categorized and treated. About 5 years ago, the U.S. National Institute of Mental Health launched a “precision medicine for psychiatry” project.
An early promising result from this project has emerged from studies that deconstruct current diagnostic groups to identify subgroups that have biological validity, and predict treatment response. For instance, imaging and neurophysiology have demonstrated three subtypes of attention deficit hyperactivity disorder (ADHD) with different responses to stimulant medication. Preliminary reports from studies using cognitive testing, imaging, and/or genomic panels are also finding biologically meaningful subgroups of psychotic or mood disorders. Notably, these biologically defined subgroups do not map neatly onto clusters of symptoms. Although these results will need replication and need to show predictive value in prognosis or treatment response, they illustrate the potential for empirically defined, convergent methods of stratifying patients.
As new diagnostics will likely be redefining “mental disorders” as “brain circuit disorders,” new therapeutics will likely focus on tuning these circuits. What is the best way to tune a negative valence or social processing circuit? Medications might be useful, but recent attention has focused on devices that invasively (deep brain stimulation) or noninvasively (transcranial magnetic stimulation) alter brain circuit activity. The authors suggest that one of the most powerful and precise interventions to alter such activity may be targeted psychotherapy, such as cognitive behavioral therapy, which uses the brain’s intrinsic plasticity to alter neural circuits and as a consequence, deleterious thoughts and behavior.
Insel TR and Cuthbert BN: Brain disorders? Precisely. Science 348 (6234): 499-500 (2015).

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