Book Review – Precision Psychiatry
Image: Precision Psychiatry by Len Lantz (CC BY-NC-ND)
Synopsis: Len's Star Rating: 10 out of 10. A visionary book on the future of understanding and treating mental disorders through the lens of measurement-based, personalized psychiatric care.
BY LEN LANTZ, MD / 12.2.2022; No. 98
Disclaimer: Yes, I am a physician, but I’m not your doctor and this article does not create a doctor-patient relationship. This article is for educational purposes and should not be seen as medical advice. You should consult with your physician before you rely on this information. This post also contains affiliate links. Please click this LINK for the full disclaimer.
Star Rating – 10 out of 10
Rating guide: 1 = horrible, 5 = average and 10 = wow
Authors
Leanne Williams and Laura Hack
About the authors
Leanne Williams, PhD, (author and editor) is a Professor of Psychiatry and Associate Chair of Translational Neuroscience at Stanford University School of Medicine. Dr. Williams is the founding director of the Stanford Center for Precision Mental Health and Wellness and of the Stanford PanLab for Precision Psychiatry and Translational Neuroscience. She holds a joint appointment as Director of the Precision Medicine Core at the Palo Alto VA Mental Illness Research, Education, and Clinical Center. Dr. Williams developed a precision neuroscience approach for application in psychiatry and has contributed over 360 scientific papers to the field of neuroscience.
Laura Hack, MD, PhD, (author and editor) is a psychiatrist, researcher, Assistant Professor in the Department of Psychiatry and Behavioral Sciences, Director of Novel & Precision Neurotherapeutics at the Stanford Center for Precision Mental Health and Wellness, and Deputy Director of the Precision Neuromodulation Clinic (PNC) within the VA Palo Alto Health Care System. Dr. Hack’s clinical specialty is in delivering interventional treatments, including transcranial magnetic stimulation (TMS) and ketamine, to patients with treatment-resistant depression and trauma-related disorders.
General description
Precision Psychiatry is a groundbreaking book on the theory and science of measurement-based and individually-tailored psychiatric care. The book covers a wide range of neuroscience topics from a large number of contributors (43 authors in total). The thrust of the book is that a lot has been learned about the brain in recent decades, yet more needs to be learned before psychiatry reaches the point of personalized diagnosis and treatment of mental illness like other fields of medicine, such as oncology, cardiology, and infectious disease. The book is divided into six sections:
Neuroimaging of Circuits
Neurocognition, Neurophysiology, and Behavior
Blood Markers
Translational Neurobiological Approaches
New Approaches and Computational Models that Bridge Neuroscience Insights and Clinical Application
Developing the Academic Discipline of Precision Psychiatry
Unique and most important aspects
Precision Psychiatry is one of the most important psychiatric texts published in decades. In full disclosure, neuroscience researchers are my heroes because of their efforts to advance what is known about the brain and how to more effectively treat mental illness. The editors of Precision Psychiatry accomplished an enormous achievement in bringing together many of the top minds and researchers in neuroscience to synthesize the most cutting-edge research to date. The foreword of the book – written by neuroscience research pioneer Dr. Helen Mayberg – shapes the vision, the need, and the hope for the future of precision psychiatry. As the authors point out, “Precision psychiatry is not yet a clinical reality,” however, the information in Precision Psychiatry presents a convincing argument that it will be the future of psychiatry.
Readers of Precision Psychiatry should be prepared to read a technical book. The text does not cover all psychiatric diagnoses but does address research findings in major depressive disorder, bipolar disorder, posttraumatic stress disorder, and schizophrenia. I was particularly blown away by chapter 4, which was titled “Information Processing Impairments as Transdiagnostic Treatment Targets in Psychiatric Disorders,” as I knew the least about this research before reading the book and this research shows tremendous promise in the treatment of mental disorders. Important features of this book include:
The role of neural circuit dysfunction in most, if not all, mental disorders
Neural mechanisms of bipolar disorder
The impact of meta-cognitive interventions
The effectiveness of treatments that employ reinforcement learning theory
The goal of personalized medicine in psychiatry (tailoring treatment)
The progress of precision psychiatry in advancing the Research Domain Criteria (RDoC) research framework spearheaded by Dr. Tom Insel at NIMH a decade ago
The need for better and more accurate treatments for individual people suffering from mental disorders
The prospect of using machine learning (artificial intelligence) and neuroimaging in assessing and treating psychiatric disorders
The influence of inflammation on mental illness
The involvement of microcircuits and epigenetic processes in threat learning
Best quotes
“…we share a common goal: to develop biomarkers and algorithms that will discriminate patient subgroups and optimize treatment selection in the management of individual patients across all stages of illness. Treatment selection is not a negotiation, but rather the best option given the current evidence. Ultimately, clinical use of such discoveries will require biomarkers that are not only robust but scalable.”
“Psychiatry is the field of medicine that is dedicated to understanding mental disorders and helping people with these conditions to live fulfilling lives and to adapt to the unique challenges they face. In their clinical practice, psychiatrists work with courageous people who experience great distress and despair and also exhibit great resilience and dignity. Psychiatry also advances knowledge of the prevention, diagnosis, and treatment of mental disorders and awareness of how much mental health and physical health go hand in hand.”
“Precision psychiatry focuses on differentiating characteristics and patterns and, in an evidence-driven manner, developing therapeutic approaches that may be most helpful to specific individuals with a specific constellation of health issues, characteristics, strengths, and symptoms.”
“Within the umbrella concept of precision approaches to psychiatry, we define personalized medicine in psychiatry (PMP) more narrowly as tailoring treatment to the individual characteristics of each patient…Tailoring mental health care to each patient’s unique characteristics will likely improve diagnostic certainty and psychiatric disorder outcomes and thereby address the staggering disease burden of these disorders.”
“Schizophrenia serves as a conceptual model that cuts across all psychiatric syndromes, which we now know all arise from neural circuit dysfunction and maladaptive system-level information processing in the brain.”
“This is consistent with basic science and clinical literature which suggests that successful cognitive training can be both neuro-restorative and neuro-protective.”
“Taken together, these data suggest that increased inflammation represents a transdiagnostic pathology that may contribute to specific symptom clusters in subgroups of patients with psychiatric and other disorders.”
Who would enjoy this book?
Educators, trainees, and clinicians interested in neuroscience advances in psychiatry are likely to enjoy Precision Psychiatry.
Who would not enjoy this book?
Readers looking for a book on “how to treat mental illness” or lay readers without a background in neuroscience are unlikely to enjoy Precision Psychiatry.
Conclusion
Precision Psychiatry is a visionary book on the future of understanding and treating mental disorders through the lens of measurement-based, personalized psychiatric care.
