Magazine article Clinical Psychiatry News

What Role Will Genetics Play in Psychiatry?

Magazine article Clinical Psychiatry News

What Role Will Genetics Play in Psychiatry?

Article excerpt

There is more to biology than genetics.

The identification of genetic factors involved in causing psychiatric disorders like schizophrenia holds great promise. But as this information becomes available, psychiatrists also must continue to attend to what schizophrenia feels like to individual patients.

The molecular characterization of a disease like schizophrenia may become enormously helpful in guiding researchers to new treatments and in helping to distinguish disease subtypes. But there is more to biology than genetics. The human brain and the disorders that can affect it are too complex to be seen exclusively through the reductionist lens of genetic research. Psychiatric illness is not just a matter of abnormal genes and malfunctioning neurons. It is, more intrinsically, what is clinically observed: unhappy and often ill people who behave aberrantly.

There is a long history in psychiatry of not paying enough attention to the complex biology of disease states. But with the increasing use of genetics and brain imaging, we see a shift toward taking biology too seriously. A better way to understand psychiatric disorders and to diagnose and manage individual patients is to use information that comes from all relevant sources.

The physician must take into account the observable clinical phenomenon of a patient's psychiatric condition as well as her genome and brain states.

In the assessment of complex patients, it's important to have as balanced a view as possible. Their disorder depends in part on their genome, in part on their brain, in part on their environment, and in part on the larger social structure in which the patient lives.

There are at least two ways to understand and apply genetic information: to classify a psychiatric disorder, and to diagnose and potentially treat individual patients. Pharmacogenetic data may also be useful for developing and prescribing drugs. An especially promising use for genetics is to link a genetic variant to a neurobiologic state that helps provide a mechanistic explanation of what is going on in the brains of patients with schizophrenia.

An example of the role that sociocultural context plays in schizophrenia can be found in the diagnostic frequency of two forms of the disorder: catatonic schizophrenia, and hebephrenia (disorganized schizophrenia). Catatonic schizophrenia, marked by a fixed state, is diagnosed much more frequently among patients in developing countries than among patients in developed countries. In contrast, hebephrenia, characterized by severe personality disintegration, is diagnosed in patients in developed countries far more often than among patients in developing countries. There is no clear explanation for this disparity, but it suggests that symptoms judged as pathological in one setting may not be viewed the same way in another setting.

Psychiatrists and other physicians need to be able to make excellent choices for their patients based on both scientific evidence and an understanding of why the patient is seeking medical care. The scientific evidence alone, including genetic information and data obtained from brain scans informs the process. But this evidence also gives an incomplete picture of what is going on inside the patient.

DR. ROBERT is a bioethicist at the center for biology and science at Arizona State University, Tempe, and at the University of Arizona-Phoenix.

JASON SCOTT ROBERT, PH.D.

The earlier we identify risk, the better. …

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