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Integrative Neuroscience and Personalized Medicine

edited by Evian Gordon, and Stephen Koslow. Oxford, United Kingdom, Oxford University Press, 2011, 322 pp., $89.95.

Reviewed by Mauricio Tohen, M.D., Dr.PH., M.B.A.
Am J Psychiatry 2011;168:1123-1124. doi:10.1176/appi.ajp.2011.11020200
View Author and Article Information
San Antonio, Tex.

Dr. Tohen is a former employee of Lilly; he has served as a consultant to or has received honoraria from AstraZeneca, Bristol-Myers Squibb, Forest, GlaxoSmithKline, Lilly, Lundbeck, Merck, Otsuka, Roche, Sunovion, and Wyeth as well as Wiley Publishers. His spouse is currently employed by and a stockholder with Lilly.

Book review accepted for publication April 2011

Accepted April , 2011.

Copyright © American Psychiatric Association

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This is an edited volume of 322 pages divided into 15 chapters. The editors have assembled a stellar group of academia and industry neuroscience contributors from the United States, Australia, Israel, and the United Kingdom.

As the editors point out in the introduction, "one size does not fit all." The goal of the volume is to update the reader on the concept of personalized medicine and to support the idea that a better understanding of the genomic regulation and other biomarkers of mental disorders will lead to improved diagnoses and treatments.

The first chapter, on the history of personalized medicine, reminds us that the concept is not a new one and provides examples going back to antiquity. Progress in the last 20 years, including public policy and legal aspects, is nicely summarized.

The second chapter, by Alan Schatzberg, provides a concise review of mostly failed attempts to characterize psychiatric conditions with biological tests, such as tests for 3-methoxy-4-hydroxy-phenylethyleneglycol levels and hypothalamic pituitary adrenal axis activity or the dexamethasone/corticotropin-releasing hormone test.

Section Two focuses on specific mental disorders. Unfortunately, only a few illnesses, such as schizophrenia, depression, and attention deficit hyperactivity disorder, are covered. Noted omissions are bipolar disorders and posttraumatic stress disorder. However, the chapter on schizophrenia is particularly comprehensive.

The chapter on functional magnetic resonance imaging (fMRI) is thoughtful and concludes with discussion on how fMRI has failed to deliver its early promise in aiding in the diagnosis of psychiatric conditions. The authors convincingly argue the need to shift away from mean group comparisons and shift toward a more promising classification-based paradigm.

The chapter on stress and its impact on personalized medicine is thorough and emphasizes the importance of genomics, brain imaging, and other biomarkers in mood and anxiety disorders. This chapter includes a clear description of the neuroendocrinology of stress and how it relates to the pathophysiology of mood and anxiety disorders. The authors' concluding message is that in the past, in order to develop new therapies we have relied on group data rather than on individual data, which many times results in failed therapies, but with the availability of new technologies, such as genomics, brain imaging, and other biomarkers, we will be able to develop a more personalized medicine: "the right treatment for the right patient at the right time."

Chapter Eight attempts to summarize the role of neuroimaging and biomarkers in psychiatric disorders. It is rather repetitive of the content in other chapters that focus on individual disorders. A chapter focusing on dementia would have added value to this volume.

Chapter Nine focuses on the autonomic nervous system. It represents a comprehensive review of psychosomatic concepts.

The reader will, perhaps, be disappointed that Chapter 10, on sleep health, does not adequately cover biological rhythms in sleep disorders or the use of sleep studies in the diagnosis of specific psychiatric conditions.

Chapter 11, on multiple sclerosis, is particularly comprehensive. It is 40 pages long, well written, and up-to-date.

Chapter 12 is on brain-related health care new models for personalized medicine in psychiatry. It highlights the fact that better clinical outcomes with personalized medicine should lead to better financial outcomes. Chapter 14, on the economic impact of the personalized medicine tsunami, is—as suggested by its title—provocative yet thoughtful. The authors point out that we are in the middle of dramatic changes in health care, including the availability of new technologies combined with new public attitudes and public policies. The authors address the "four Ps" of research of the National Institutes of Health: predictive, personalized, preemptive, and participatory, namely, that the "participation" of a diverse group of people in diverse settings is needed in order to increase our capacity to "predict" who is at risk in order to develop new therapies to "preempt" the development of disease by using "personalized" interventions. The authors also address challenges of new policies, such as the Mental Health Parity and Addiction Equity Act of 2008, which, in order to succeed, will need to be accompanied by new treatment solutions to fulfill the demand of the expanded coverage.

The last chapter, written by the editors and titled "Accelerating the Future of Personalized Medicine," is a thoughtful, concise summary of the future, with a convincing call for action. Of note, readers should be aware that Dr. Gordon is the chief executive officer of a private company that is currently funding research efforts in the area of personalized medicine for pharmaceutical development, which suggests that he has close knowledge of the challenges faced in this arena and a motivation for its success.




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