Personalized medicine in the treatment of psychosis
Personalized medicine is transforming how we understand and treat various health conditions, and psychosis is no exception. This approach, which integrates advances in genetics, technology, and neurobiology , allows for more precise and effective care for each individual, tailoring treatments to their specific characteristics.
Until now, the treatment of psychosis in its early stages was based on standardized protocols that established guidelines on what type of treatment to use and for how long, without being able to determine which of the available treatments was the most suitable for each person.
Treatment for psychosis includes the use of antipsychotic medications , which help reduce symptoms such as hallucinations or delusions. In some cases, these medications are combined with other drugs to treat additional symptoms, such as anxiety or mood disorders. However, the approach is not solely pharmacological; psychosocial interventions are also essential and include:
- Psychological therapy.
- Family support.
- Work and social rehabilitation.
- Strategies to improve quality of life.
Not everyone responds to or tolerates antipsychotics or available psychotherapies in the same way. This is where personalized medicine represents a major advance. Its goal is to identify, through genetic, neurobiological, and clinical studies , which specific antipsychotic treatment or combination of treatments will be most effective for a person from the outset, as well as determining the most appropriate add-on treatment (for example, for anxiety or mood) or which psychotherapy is best suited for that individual. It will also allow for adjusting the duration of treatment according to each person's specific needs.
Through genetic, neurobiological, and clinical studies, it is possible to identify which specific antipsychotic treatment or combination of treatments will be most effective for a person.
This approach can reduce medication side effects and improve symptom control from the outset. This translates into a better quality of life for those experiencing psychosis, facilitating a faster and more effective recovery and reintegration into their daily activities.
What is the basis of personalized medicine in the treatment of psychosis?
Personalized medicine is based on the idea that each person is unique and that their response to treatments depends on a multitude of factors. These include genetic factors, which are part of our DNA, and environmental factors, which include lifestyle and the environment in which we live. Both influence our body and brain function, determining our sensitivity and response to different treatments.
To better understand these individual differences, personalized medicine seeks to identify biological signals that help us predict how each person will respond to treatments. These signals are called biomarkers , and there are several types, each related to key mechanisms in the development of psychosis, including:
Genetic biomarkers
These variations refer to changes in specific genes or sets of genes that can influence the risk of developing psychosis or the response to treatment. For example, variations in genes that code for enzymes involved in drug metabolism (such as CYP2D6 or CYP3A4) affect how antipsychotics are processed, influencing their effectiveness and the occurrence of side effects. Furthermore, variations in genes related to dopamine and glutamate neurotransmission, which are altered in psychosis, can help predict which individuals will respond best to certain antipsychotics.
Epigenetic biomarkers
These changes refer to alterations in gene expression without any alteration in the DNA sequence. These changes can be triggered by environmental factors such as chronic stress, substance use, or traumatic events, all of which are known risk factors for the development of psychosis. For example, the expression of genes related to synaptic plasticity and the regulation of the hypothalamic-pituitary-adrenal (HPA) axis can be altered, affecting vulnerability to stress and response to treatment.
It will be possible to reduce the side effects of medications and improve symptom control from the outset, thus improving the quality of life for people experiencing psychosis.
Biomarkers based on proteins and other biological substances
These include molecules that reflect biological processes involved in the disorder, such as inflammation or neuroplasticity. For example, neurotrophins (such as brain-derived neurotrophic factor, BDNF) are involved in neuronal survival and growth, and their altered levels have been linked to the synaptic dysfunction observed in psychosis. Similarly, proinflammatory cytokines (such as interleukins IL-6 and IL-1β) are implicated in inflammatory processes that could contribute to the development of psychotic symptoms.
Proteomics
Instead of focusing on a single protein, proteomics allows the study of the entire set of proteins present in a cell or tissue. This is useful because psychosis is not caused by a single biological alteration, but by a complex interaction of multiple factors. Analyzing the overall protein profile allows the identification of dysfunctional patterns in key biological networks, neuronal signaling, or the inflammatory response, which could guide the selection of more targeted treatments for each individual.
Biomarkers of the gut microbiome
There is growing evidence of a connection between the gut and the brain, known as the gut-brain axis. It has been observed that some people with psychosis have alterations in the composition of their gut microbiome, which could influence neuroinflammation, blood-brain barrier function, and neurotransmitter synthesis.
Neuroimaging biomarkers
These biomarkers are obtained using neuroimaging techniques such as structural and functional magnetic resonance imaging (MRI) or nuclear medicine studies (PET, SPECT). They allow for the evaluation of alterations in brain structure, such as reductions in the volume of the cerebral cortex or other brain structures, as well as dysfunctions in neuronal function and connectivity or in the activity of dopaminergic circuits, which are involved in the development of psychotic symptoms.
Metacognitive training: learning to think better
How will personalized medicine be applied when starting treatments?
When a person begins a psychotic process, instead of following a standardized protocol, personalized medicine will adapt the therapy to their individual characteristics.
To this end, a comprehensive initial assessment will be performed, which may include clinical, genetic, and epigenetic analyses, along with blood biomarkers, neuroimaging, and gut microbiome analysis. This information will allow us to predict the response to and tolerance of the treatment from the outset.
Although promising progress is already being made in research, more time and further studies are still needed before this approach can be implemented in routine practice.
With this data, a tailor-made treatment will be designed, choosing the most appropriate medication, adjusting the dose in a personalized way and combining psychological therapies with lifestyle changes to optimize the results.
This approach will reduce side effects, improve treatment effectiveness, decrease the risk of relapse, and increase the quality of life for people with psychosis, ensuring a faster and more effective recovery.
Personalized medicine represents a revolution in the treatment of psychosis, as it allows for a more precise and tailored approach to the disorder. However, it is important to note that, although promising advances are already being made in research, more time and further studies are needed before this approach can be implemented in routine practice.
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