New research published in JAMA Psychiatry indicates that the treatment of psychosis may be based on fundamentally flawed assumptions. For years, psychiatrists have categorized psychosis into distinct conditions, such as schizophrenia and bipolar disorder, leading to varied treatment approaches. However, this latest study suggests that the underlying brain changes associated with psychotic symptoms are remarkably similar across these diagnoses.
Psychosis is characterized by symptoms that can deeply distress individuals, including hallucinations and delusions. These experiences can cause significant difficulty in distinguishing reality from perception. The research focused on 38 individuals experiencing their first episode of psychosis, with some also exhibiting mood symptoms. The subjects were compared to healthy volunteers to assess brain function.
The study utilized advanced brain imaging techniques to evaluate dopamine synthesis, a neurotransmitter linked to motivation and reward, in different brain regions. Findings revealed that while individuals experiencing manic episodes had higher dopamine synthesis in areas related to emotion processing, a consistent pattern emerged: higher dopamine synthesis in regions responsible for thinking and planning correlated with more severe psychotic symptoms, such as hallucinations and delusions.
This discovery challenges the prevailing reliance on diagnostic categories for treatment decisions. Currently, two individuals exhibiting identical symptoms might receive different medications solely based on their diagnosis. The research indicates that dopamine dysfunction varies among those experiencing psychosis, suggesting a need for treatment approaches that align with the biological underpinnings of these symptoms rather than traditional diagnostic labels.
Shifting to Precision Psychiatry
The implications of this research could be transformative. Rather than using psychiatric categories as the sole basis for treatment, healthcare providers may begin to employ biological markers to determine the most effective medications for patients. This method, referred to as precision psychiatry, draws parallels to how oncologists tailor cancer treatments based on the genetic characteristics of tumors.
For individuals experiencing psychosis, this could lead to more rapid recovery and reduced side effects. Currently, patients often endure prolonged suffering as they cycle through various medications that may not effectively address their symptoms. The study suggests that those with significant mood symptoms might respond better to medications targeting emotion-processing circuits, while individuals without mood disorders may require different treatment strategies focused on cognitive functions.
While the research underscores the importance of psychiatric diagnoses for healthcare organization and communication among professionals, it raises questions about their efficacy in guiding medication selection.
The study involved a relatively small cohort, and further research is necessary to validate these findings in larger populations before clinical practice can be significantly altered. Nonetheless, this work represents a critical advancement toward a more scientifically informed and biology-based approach to addressing one of psychiatry’s most complex challenges.
As understanding of the brain continues to evolve, the rigid categories that have historically defined psychiatric practice may begin to dissolve. If the brain operates beyond these diagnostic boundaries, it may be time for treatment strategies to follow suit.
This study was conducted by Sameer Jauhar, Clinical Associate Professor at Imperial College London, and Robert McCutcheon, Wellcome Clinical Research Career Development Fellow at University of Oxford. The findings signal a pivotal moment in mental health treatment, where a more nuanced understanding of psychosis could ultimately enhance patient care.
