Gaia Sampogna
Peter Falkai2
Tomasz Gondek
Andrea Fiorillo- 1Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
- 2Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University (LMU) Munich University Hospital, Munich, Germany
- 3Self-employed, Wrocław, Poland
Editorial on the Research Topic
New trends in psychiatric research: Toward the clinical characterization of the individual case and the personalization of treatments
Research in psychiatry is undergoing major changes due to continuous upheavals in psychological, social and environmental factors which have an impact on mental health and mental disorders (1). In particular, there is now an increasing interest toward personalized medicine in order to put the patient at the core of the care pathway (2). From a diagnostic viewpoint, it is recognized that many syndromes cannot be anymore diagnosed by simply fulfilling categorical criteria, but many symptoms overlap among psychiatric syndromes. Many of what we call mental disorders, although not qualifying at the moment as proper “disease entities,” are indeed patterns of observed signs and reported symptoms that trained clinicians have been able to recognize for decades in a variety of clinical contexts (3). Psychiatrists need a conceptual framework which acknowledges the complexity of mental disorders and indicates the type of information to be collected in order to personalize individualized treatment plans. There is the need to further characterize the individual patient with a given mental disorder, besides its signs and symptoms, in order to personalize the management plan and to promote patients' full personal recovery.
However, research evidence is still fragmentary, the selection of pharmacological and psychosocial treatments is usually based on clinicians' and/or patients' preferences as well as on safety issues, in a trial-and-error fashion, paying little or no attention to the particular features of the specific case. In ordinary clinical practice, psychiatrists refer to adopt a personalized approach for patients with severe mental disorders, although systematic guidelines are missing (4). This is why many patients suffering from severe mental disorders, such as major depression or schizophrenia, do not achieve remission with the first treatment they receive (5). Therefore, the more precise clinical characterization of these patients will enhance the provision of personalized management and the likelihood of obtaining optimal outcomes (6).
Orienting research toward the clinical characterization of the individual patient should lead to a renewed interest toward a transdiagnostic approach of mental disorders, rather than a categorical one (7). Indeed, the most recent editions of both ICD and DSM classification systems have tried to include some dimensional aspects—such as for the classification of personality disorders—confirming the need for a comprehensive and balanced evaluation of different psychopathological domains (8, 9).
The clinical characterization of the individual patient requires the evaluation of several domains, including clinical symptoms, severity of illness, clinical subtypes, level of functional status, staging of illness, medical and psychiatric comorbidities, early life adverse event(s), personality traits, environmental stressors, recovery styles and coping strategies (10–12). All these aspects are transdiagnostic and have been often overlooked by younger generation of psychiatrists, looking only at number of symptoms needed to fulfill diagnostic criteria. A transdiagnostic approach is useful also for the identification of risk and protective factors of mental disorders. As recently pointed out by Arango et al. (13), transdiagnostic risk/protective factors—such as childhood adversities, stressful events, being second generation immigrant—are mostly involved in the early neurodevelopmental period (14). The evidence is rapidly growing on the interaction between gene-by-environment-by-time of exposure, highlighting that environmental factors underly much of the variation in clinical and neurobiological phenotypes of mental disorders and their outcomes (15, 16).
New trends of research include the study of people in specific phases of their life (such as the perinatal period) (17–19) or in specific settings (such as refugee camps or war conflicts) (20, 21) in order to identify the impact of specific social stressors as possible risk factors for the development of mental disorders. Finally, although the neurobiological approach has failed to detect the “unique cause” of mental disorders, the progress in the identification and clinical use of biomarkers will be facilitated through multidimensional clinical assessment. It is indeed plausible that biomarkers will be found to correlate more closely with dimensions of psychopathology than with categorical diagnostic measures, which often hide important treatment-relevant aspects of illness. As such, biomarkers may become more useful as predictive factors, mediators or moderators of the variability in outcome response (22–24).
In the present Research Topic entitled “New trends in psychiatric research: Toward the clinical characterization of the individual case and the personalization of treatments” several original studies have addressed the issue of the personalization and individual characterization of each single patient from different point of view. In particular, some studies have been focused on the role of psychological resources and vulnerabilities as predictors of good outcome in different psychotherapies or on the sex-based differences in patients with affective disorders (Menculini et al.). Moreover, we have included papers dealing with the impact of the COVID-19 pandemic on patients' wellbeing and mental health, as well as on peripheral biomarkers of inflammation and its association with personal functioning (Chumakov et al.).
There is the need to further promote research in this field, but we hope that contributions collected in this Research Topic will be useful to improve the clinical characterization of the individual patients.
Author contributions
All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Alegría M, NeMoyer A, Falgàs Bagué I, Wang Y, Alvarez K. Social determinants of mental health: where we are and where we need to go. Curr Psychiatry Rep. (2018) 20:95. doi: 10.1007/s11920-018-0969-9
2. Pompili M, Giordano G, Luciano M, Lamis DA, Del Vecchio V, Serafini G, et al. Unmet needs in schizophrenia. CNS Neurol Disord Drug Targets. (2017) 16:870–84. doi: 10.2174/1871527316666170803143927
3. Maj M, Stein DJ, Parker G, Zimmerman M, Fava GA, De Hert M, et al. The clinical characterization of the adult patient with depression aimed at personalization of management. World Psychiatry. (2020) 19:269–93. doi: 10.1002/wps.20771
4. Perlis RH. Translating biomarkers to clinical practice. Mol Psychiatry. (2011) 16:1076–87. doi: 10.1038/mp.2011.63
5. Maj M, van Os J, De Hert M, Gaebel W, Galderisi S, Green MF, et al. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry. (2021) 20:4–33. doi: 10.1002/wps.20809
6. Reynolds CF. Optimizing personalized management of depression: the importance of real-world contexts and the need for a new convergence paradigm in mental health. World Psychiatry. (2020) 19:266–8. doi: 10.1002/wps.20770
7. Heckers S, Kendler KS. The evolution of Kraepelin's nosological principles. World Psychiatry. (2020) 19:381–8. doi: 10.1002/wps.20774
8. Pettersson E, Larsson H, D'Onofrio BM, Bölte S, Lichtenstein P. The general factor of psychopathology: a comparison with the general factor of intelligence with respect to magnitude and predictive validity. World Psychiatry. (2020) 19:206–13. doi: 10.1002/wps.20763
9. Luciano M, Sampogna G, Del Vecchio V, Giallonardo V, Palummo C, Pocai B, et al. The Italian ICD-11 field trial: clinical utility of diagnostic guidelines for schizophrenia and related disorders. Int J Ment Health Syst. (2020) 14:4. doi: 10.1186/s13033-020-0338-z
10. Volpe U, Fiorillo A, Luciano M, Del Vecchio V, Palumbo C, Calò S, et al. Pathways to mental health care in Italy: results from a multicenter study. Int J Soc Psychiatry. (2014) 60:508–13. doi: 10.1177/0020764013501648
11. Sampogna G, Del Vecchio V, Giallonardo V, Luciano M, Albert U, Carmassi C, et al. What is the role of resilience and coping strategies on the mental health of the general population during the COVID-19 pandemic? Results from the Italian multicentric COMET study. Brain Sci. (2021) 11:1231. doi: 10.3390/brainsci11091231
12. Ayerbe L, Pérez-Piñar M, Foguet-Boreu Q, Ayis S. Psychosis in children of separated parents: a systematic review and meta-analysis. Eur Psychiatry. (2020) 63:e3. doi: 10.1192/j.eurpsy.2019.15
13. Arango C, Dragioti E, Solmi M, Cortese S, Domschke K, Murray RM, et al. Risk and protective factors for mental disorders beyond genetics: an evidence-based atlas. World Psychiatry. (2021) 20:417–36. doi: 10.1002/wps.20894
14. Duarte CS, Monk C, Weissman MM, Posner J. Intergenerational psychiatry: a new look at a powerful perspective. World Psychiatry. (2020) 19:175–6. doi: 10.1002/wps.20733
15. Erzin G, Pries LK, van Os J, Fusar-Poli L, Delespaul P, Kenis G, et al. Examining the association between exposome score for schizophrenia and functioning in schizophrenia, siblings, and healthy controls: Results from the EUGEI study. Eur Psychiatry. (2021) 64:e25. doi: 10.1192/j.eurpsy.2021.19
16. Mollon J, Knowles EEM, Mathias SR, Rodrigue A, Moore TM, Calkins ME, et al. Genetic influences on externalizing psychopathology overlap with cognitive functioning and show developmental variation. Eur Psychiatry. (2021) 64:e29. doi: 10.1192/j.eurpsy.2021.21
17. Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. (2020) 19:313–27. doi: 10.1002/wps.20769
18. Khapre S, Stewart R, Taylor C. An evaluation of symptom domains in the 2 years before pregnancy as predictors of relapse in the perinatal period in women with severe mental illness. Eur Psychiatry. (2021) 64:e26. doi: 10.1192/j.eurpsy.2021.18
19. Glover V. Prenatal mental health and the effects of stress on the foetus and the child. Should psychiatrists look beyond mental disorders? World Psychiatry. (2020) 19:331–2. doi: 10.1002/wps.20777
20. Silove D. Challenges to mental health services for refugees: a global perspective. World Psychiatry. (2021) 20:131–2. doi: 10.1002/wps.20818
21. van der Wal SJ, Vermetten E, Elbert G. Long-term development of post-traumatic stress symptoms and associated risk factors in military service members deployed to Afghanistan: results from the PRISMO 10-year follow-up. Eur Psychiatry. (2020) 64:e10. doi: 10.1192/j.eurpsy.2020.113
22. De Rosa C, Sampogna G, Luciano M, Del Vecchio V, Fabrazzo M, Fiorillo A, et al. Social versus biological psychiatry: it's time for integration! Int J Soc Psychiatry 64. (2018) 617–21. doi: 10.1177/0020764017752969
23. Correia C, Alcobia L, Lopes MJ, Advinha AM. Pharmacogenomic biomarkers as source of evidence of the effectiveness and safety of antidepressant therapy. BMC Psychiatry. (2022) 22:576.
Keywords: clinical characterization, dimensional, categorical approach, individual patient, personalization of treatment
Citation: Sampogna G, Falkai P, Gondek T and Fiorillo A (2022) Editorial: New trends in psychiatric research: Toward the clinical characterization of the individual case and the personalization of treatments. Front. Psychiatry 13:1042536. doi: 10.3389/fpsyt.2022.1042536
Received: 12 September 2022; Accepted: 20 September 2022;
Published: 06 October 2022.
Edited and reviewed by: Wulf Rössler, Charité Universitätsmedizin Berlin, Germany
Copyright © 2022 Sampogna, Falkai, Gondek and Fiorillo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Gaia Sampogna, Z2FpYS5zYW1wb2duYSYjeDAwMDQwO2dtYWlsLmNvbQ==