Global Journal of Medical Research, A: Neurology & Nervous System, Volume 23 Issue 3

A Precision Medicine Approach to the Treatment of Psychiatric Disorders Michael Raymond Binder, M.D. Abstract- Due to a lack of clarity about the pathophysiology of psychiatric disorders, short and long-term treatment outcomes continue to be very inconsistent, and the prescribing of multiple medications that can have unpredictable, conflicting, and sometimes paradoxical effects continues to be more the rule than the exception in modern psychiatric practice. Dosing is also an issue, as standard doses of psychotropic drugs are often too high, thus causing some patients to incur unnecessary side effects, which in turn can lead to poor compliance or even discontinuation of treatment. Worse yet, these negative outcomes can cause disappointed patients to dissuade other would-be patients from seeking treatment. Recognizing these concerns and the fact that most persons with mental illness never seek treatment to begin with, the need for greater precision and fewer side effects in the prescribing of psychotropic drugs cannot be overstated. Based on an emerging hypothesis on the pathophysiology of psychiatric disorders, this article will discuss a promising new approach to psychopharmacotherapy that has the potential to simplify drug selection, reduce dosing requirements, and minimize side effects. By targeting the core physiological abnormality in psychiatric disorders, the use of medications that have unpredictable, conflicting, and sometimes paradoxical effects can be minimized, and the lowest doses of the most appropriate drugs can be used to achieve faster, more consistent, and more enduring therapeutic effects in a group of disorders that are now considered to be a public health crisis. Keywords: neuronal hyperexcitability, psychotropic drugs, antidepressants, antipsychotics, psychostimulants, anticonvulsants, mood stabilizers, neuroregulators, mental health, medication side effects, mental health crisis, preventive medicine. I. I ntroduction ue to a lack of clarity about the pathophysiology of psychiatric disorders, treatment outcomes in psychiatry continue to be very inconsistent [1, 2], and the prescribing of multiple medications that can have unpredictable, conflicting, and sometimes paradoxical effects has become more the rule than the exception [3]. Many patients are also confused about their diagnosis and how it relates to their treatment. Of equal concern is the fact that most patients who need psychiatric care fail to seek care. Based on data from the Mental Health Million project [4], which polled the English-speaking population of 10 countries, 58% of those questioned did not seek help for clinically Author: Adult and Adolescent Psychiatry, 5 Revere Drive, Suite 200, Northbrook, USA. e-mail: mbinder@drmichaelbinder.com apparent mental health issues. In the United Kingdom, only 50% sought help, and in the United States, only 45% sought help. The possible reasons for these low numbers include limited access to care, insufficient financial resources, failure to recognize one’s need for care, lack of confidence in the benefits of care, the stigma of mental illness, and fear of taking psychotropic drugs [5]. This last reason—fear of taking psychotropic drugs—usually centers around concerns that such drugs could cause a change in personality, a worsening of symptoms, debilitating side effects, or social stigma. Therefore, with all of these concerns looming in the mind of the patient, it is incumbent upon clinicians to clearly explain what pathological process they are treating when they prescribe psychotropic medication. Clinicians should also strive to minimize both the number of medications and the side effects of those medications. However, the problem that clinicians face is that the underlying cause of most psychiatric disorders remains unclear. Consequently, they can neither visualize what they are treating nor can they properly explain to patients what they are treating. This article will discuss a promising new approach to psychopharmacotherapy that, based on new insights into the pathophysiology of psychiatric disorders, has the potential to guide better patient education about treatment, improve the quality of treatment, and minimize the side effects of treatment. By targeting the core physiological abnormality in psychiatric disorders, the use of drugs that have unpredictable, conflicting, and sometimes paradoxical effects can be replaced by drugs that, being directed squarely at the biological target, can achieve faster, more consistent, and more enduring therapeutic effects. II. B ackground of P sychotropic D rug S election Historically and still today, the medical treatment of psychiatric disorders is primarily symptom- based rather than pathology-based. This is the unfortunate consequence of a lack of consensus on the pathophysiology of psychiatric disorders. Although many behavioral health experts believe that most of the common psychiatric disorders, such as generalized anxiety disorder, major depressive disorder, bipolar disorder, and schizophrenia, are rooted in a shared biological abnormality [6-9], there are still many who D 25 Year 2023 Global Journal of Medical Research Volume XXIII Issue III Version I ( D ) A © 2023 Global Journals