Research published in JAMA Psychiatry indicates that current treatment methods for psychosis, which include diagnoses like schizophrenia and bipolar disorder, may be fundamentally flawed. For decades, psychiatrists have treated these conditions as distinct, prescribing different medications based on specific diagnoses. This study challenges that approach, suggesting that the underlying brain changes associated with psychotic symptoms are strikingly similar across various mental health disorders.
Psychosis is characterized by symptoms such as hallucinations and delusions, which can severely impact an individual’s ability to distinguish reality from perception. Symptoms can be particularly distressing, manifesting as auditory hallucinations or unfounded beliefs. The current study explored the experiences of 38 individuals undergoing their first episode of psychosis with mood symptoms, comparing their brain activity to that of healthy volunteers.
Utilizing advanced brain scanning technology, researchers measured the synthesis of dopamine, a neurotransmitter linked to motivation and reward, across different regions of the brain. The findings revealed that while individuals with manic episodes exhibited higher dopamine synthesis in areas related to emotion processing compared to those experiencing depression, a consistent pattern emerged. Higher dopamine synthesis in regions associated with thinking and planning was linked to more severe psychotic symptoms, regardless of the individual’s specific diagnosis.
This research raises significant questions about the traditional reliance on diagnostic categories in psychiatric treatment. Currently, two patients with identical symptoms may receive different medications solely based on their diagnostic labels. The study suggests that dopamine dysfunction is not uniform across all cases of psychosis, indicating a need for a more tailored approach to treatment.
Towards Precision Psychiatry
The implications of this study are profound. Rather than relying solely on psychiatric diagnoses, the adoption of precision psychiatry could allow clinicians to use biological markers to determine the most effective medications for patients. This method resembles the way oncologists personalize cancer treatments based on the genetic characteristics of tumors.
For individuals experiencing psychosis, this shift could lead to quicker recoveries and reduced side effects by minimizing the trial-and-error process often required to find effective treatments. Many patients endure prolonged suffering while trying various medications that may not address their specific symptoms.
The research suggests that those with pronounced mood symptoms may benefit from medications targeting emotion-processing circuits in the brain, while those without mood disorders might require different approaches aimed at cognitive function. Some individuals might even need treatments that simultaneously address both cognitive issues and psychotic symptoms.
While psychiatric diagnoses still play a crucial role in organizing healthcare services and facilitating communication among professionals, they may no longer be the most effective guide for medication selection. The study’s authors acknowledge that their findings are based on a relatively small sample size and require validation in larger populations before prompting changes in clinical practices.
As understanding of the brain continues to evolve, the rigid categories that have historically defined psychiatric diagnoses are beginning to dissolve. If the complexities of the brain do not adhere to these boundaries, it stands to reason that treatment approaches should be equally flexible.
Sameer Jauhar, Clinical Associate Professor at Imperial College London, and Robert McCutcheon, Wellcome Clinical Research Career Development Fellow at University of Oxford, emphasize that this research marks a significant advancement toward a more scientific approach to treating one of psychiatry’s most challenging symptoms. As the field progresses, it may lead to more effective and individualized treatment strategies for those experiencing psychosis.
