Challenges and Objectives of Precision Psychiatry
The development of psychiatric medications has significantly lagged behind other medical specialties, with very few new drugs developed over the past 50 years. This situation persists despite major advances in research on both normal brain function and the understanding of major psychiatric disorders, such as depression, bipolar disorders, schizophrenia, and autism spectrum disorders. As a result, clinicians still rely on the same medications, often discovered by chance decades ago, most of which have only moderate effectiveness and may involve significant side effects [1].
This delay can be explained by a range of barriers, including the persistence of stigma and a general lack of awareness of psychiatry within society. This has led to relatively low levels of both public and private investment compared with other areas of medicine, as well as often unnecessary regulatory obstacles and the absence of a coordinated international programme to drive progress.
Mental disorders are the leading cause of disability worldwide, affecting more than 27% of the European population each year. Their economic impact exceeds €600 billion annually.
The situation is alarming in France and worldwide. According to the World Health Organization, at least one in three people is affected by a mental disorder [2], which explains why the prevalence and economic burden of mental disorders exceed those of cardiovascular diseases, cancer, and diabetes. Mental disorders are the leading cause of disability worldwide, affecting more than 27% of the European population each year, with an economic impact exceeding €600 billion annually. More than 80 million citizens in the European Union - up to 18% of the general population - will experience some form of mental disorder during their lifetime.
Mental disorders, which often begin early in life, currently account for five of the ten leading causes of disability worldwide. In addition to the psychosocial burden they impose, major psychiatric disorders reduce life expectancy by 15 to 20 years, largely due to physical comorbidities and suicide.
One of the barriers to innovation lies in the fact that diagnostic strategies in psychiatry have remained largely unchanged for decades. They are still based on subjective assessments of signs and symptoms, classified using the criteria of diagnostic manuals such as the DSM-5 and the ICD-11. These approaches produce categorical, overlapping, and heterogeneous diagnostic entities, lacking objective biomarkers. This results in treatment strategies with limited specificity and, above all, ones that do not target precise underlying pathophysiological mechanisms [3].
Precision medicine can be used to accurately characterise and identify individuals who have, or are at risk of developing, a disease.
To overcome these limitations, current hopes lie in research in precision psychiatry. This approach follows the example of ongoing breakthroughs in precision medicine, particularly in oncology, where chemotherapy strategies are now selected based on the genetic profile of a tumour rather than its location. Similarly, in Alzheimer’s disease, there is a major shift from a clinical approach based on identifying cognitive impairment and its functional consequences to a diagnosis based on blood biomarkers that reflect underlying pathophysiological processes.
The special issue of Médecine/Sciences, published to coincide with the launch of the French national research programme in precision psychiatry - selected as part of the France 2030 initiative (PEPR PROPSY) - aims to describe the objectives and methods of precision psychiatry research that will be deployed in France.
Precision medicine can be used to accurately characterise and identify individuals who have, or are at risk of developing, a disease, to predict their prognosis, and to select more targeted treatment strategies. Its objective is to provide each patient with a tailored therapeutic approach based on the subgroup to which they belong, using a multidimensional classification grounded in clinical data and enriched by objective, measurable, and quantifiable markers - whether digital, biological (e.g. blood-based), neuroimaging, or electrophysiological [4].
In this special issue, healthcare professionals and researchers present data from the literature to prioritise transdiagnostic dimensions to be tested in patients with bipolar disorders, recurrent depression, schizophrenia, and autism spectrum disorders, within the French Minds cohort of PEPR PROPSY. These dimensions are selected based on clinical, biological, preclinical, and therapeutic evidence, contributing to a rethinking of current psychiatric classification systems. They are characterised by their presence across multiple disorders (hence the concept of “transdiagnostic” dimensions), their measurability, their association with biomarkers, their basis in specific aetiological mechanisms, their potential as targets for therapeutic strategies, and their recognition by patients as sources of impairment or functional difficulty.
The selected dimensions presented in this special issue include anhedonia, impulsivity and suicidal behaviours, sensory abnormalities, neurodevelopmental alterations, negative symptoms, and cognitive flexibility. This exceptional issue also highlights early successes in precision psychiatry, including the use of brain imaging, immunometabolism, sleep disorders, and electrophysiology in targeted therapeutic strategies.
Conflicts of interest
The author declares no conflicts of interest regarding the data published in this article.
1 https://health.ec.europa.eu/non-communicable-diseases/mental-health_en
Références
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→ Médecine/Sciences, numéro mai 2025 “Enjeux etobjectifs de la psychiatrie deprécision”
→ Precision psychiatry roadmap: towards a biology-informed framework for mental disorders
→ Should Inflammation Be a Specifier for Major Depression in the DSM-6?
→ Advancing precision psychiatry and targeted treatments: Insights from immunopsychiatry
