Editorial: Precision psychiatry and the clinical care for people with schizophrenia: sex, race and ethnicity in relation to social determinants of mental health

Abstract

Personalized psychiatry, dubbed 'Precision Psychiatry' is a field that has developed because of the many genetic findings that have recently emerged across all major psychiatric disorders and follows the lead from a similar focus in all medical disciplines. One medication, one dose and one treatment plan no longer is the way to treat all patients with similar diagnoses. There is a new journal in this field called Personalized Medicine in Psychiatry, published by Elsevier (https://www.journals.elsevier.com/personalized-medicine-in-psychiatry) and The first Congress of Precision Psychiatry was recently held this year (https://mghcme.org/syllabi/precisionpsychiatry) as well. Despite these initiatives, precision psychiatry is still in its infancy. Yet, a few easily determined demographic factors can be taken into account to move towards more personalized treatment of patients with a psychosis.Age has long been used for tailoring treatments [1], by reduced doses and treatment of concurrent medical comorbidities, but other factors are now recognized to be of importance for individualizing care, such as environmental social determinants of health, genetic variation and cognitive status. Sex of the individual has historically been only secondarily considered at best in psychiatric research. As a result, research that is specifically relevant to women in different age groups is scarce, specifically when considering type and dose of medications. How do we know that women have the same responses compared with men and metabolize the medications in a similar fashion? Certainly, their body fat distributions are different, as are other aspects of their physiology that are relevant to medication metabolism. Women with psychoses have a more variable age of onset, more predominant affective symptoms, milder negative symptoms and relative absence of comorbid substance abuse than men, for example [2]. The duration of untreated psychosis is longer in women than in men [3]. This does not mean that psychotic women are not receiving any care, they are in fact mostly in care, but for other disorders such as depression, anxiety disorder or

Long-acting Injectable Antipsychotics during the COVID-19 pandemic in schizophrenia: An observational study in a real-world clinical setting

“…The proportion of non-Italian participants in the study was 15.3%. Several studies show that COVID-19 pandemic increased pre-existing social and health-related inequities, and this is also true in the field of mental health ( Gibson et al., 2021 ; Miconi et al., 2021 ; Reme et al., 2022 ; Sommer and DeLisi, 2022 ). There is also evidence that, in some contexts, LAI treatments are disproportionately used in patients of ethnical and cultural minorities: for instance, in the USA they are more used in Black patients than in White patients ( Brown et al., 2014 ; Lawson et al., 2015 ).…”

Restoring the missing person to personalized medicine and precision psychiatry

“…RDoC has reserved a place for these larger scale processes beyond the individual as a separate dimension, labeled “environment” 1 and, although it remains to be elaborated, recent efforts to unpack this dimension identify multiple parameters related to illness course, treatment response and outcome (e.g., Carter et al, 2021 ). The importance of the social environment for the onset, course, and outcome of psychiatric disorders is evident from a wealth of research on social determinants of mental health ( Alegría et al, 2018 ; Jeste and Pender, 2022 ; Sommer and DeLisi, 2022 ). However, incorporating this dimension in research requires careful elaboration and consideration of context that goes beyond a simple checklist of environmental factors or indicators.…”