Can an Integrated Science Approach to Precision Medicine Research Improve Lithium Treatment in Bipolar Disorders?

Frontiers in Psychiatry

Jan Scott⁴  Bruno Etain⁵  Frank Bellivier⁵ 

[1] AP-HP, Groupe Henri Mondor-Albert Chenevier, Pôle de Psychiatrie, Créteil, France;AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand Widal, Paris, France;Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom;Faculté de Médecine, Université Paris Diderot, Paris, France;INSERM, Unité 955, IMRB, Equipe de Psychiatrie Translationnelle, Créteil, France;INSERM, Unité UMR-S 1144, Variabilité de Réponse aux Psychotropes, Université Paris Descartes-Paris Diderot, Paris, France;Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom;

关键词: bipolar disorders;    lithium;    mood stabilizers;    prediction;    response;    phenotype;   

DOI  :  10.3389/fpsyt.2018.00360

来源: DOAJ

【 摘 要 】

Clinical practice guidelines identify lithium as a first line treatment for mood stabilization and reduction of suicidality in bipolar disorders (BD); however, most individuals show sub-optimal response. Identifying biomarkers for lithium response could enable personalization of treatment and refine criteria for stratification of BD cases into treatment-relevant subgroups. Existing systematic reviews identify potential biomarkers of lithium response, but none directly address the conceptual issues that need to be addressed to enhance translation of research into precision prescribing of lithium. For example, although clinical syndrome subtyping of BD has not led to customized individual treatments, we emphasize the importance of assessing clinical response phenotypes in biomarker research. Also, we highlight the need to give greater consideration to the quality of prospective longitudinal monitoring of illness activity and the differentiation of non-response from partial or non-adherence with medication. It is unlikely that there is a single biomarker for lithium response or tolerability, so this review argues that more research should be directed toward the exploration of biosignatures. Importantly, we emphasize that an integrative science approach may improve the likelihood of discovering the optimal combination of clinical factors and multimodal biomarkers (e.g., blood omics, neuroimaging, and actigraphy derived-markers). This strategy could uncover a valid lithium response phenotype and facilitate development of a composite prediction algorithm. Lastly, this narrative review discusses how these strategies could improve eligibility criteria for lithium treatment in BD, and highlights barriers to translation to clinical practice including the often-overlooked issue of the cost-effectiveness of introducing biomarker tests in psychiatry.

【 授权许可】

Unknown