在精準醫學時代的臨床精神醫療

Psychiatric Practice in the Era of Precision Medicine

美國於完成人類基因體計畫之後，由總統歐巴馬於 2015 年 1 月宣布將進行精準醫學的 大型研究計畫，將個人的基因體資訊與與臨床資料進行聯結與整合，以落實個人化醫療。此 計畫的執行者，美國國家衛生研究院院長說初期將以癌症為目標，長期目標則是將推廣到各 種疾病。精神醫學為臨床醫學的一支，在此風潮的影響之下，將會受到一些衝擊。本綜說將 精神醫學的演進放進生物醫學演進的歷史脈絡中審視，從心理學時期進入生物精神醫學，再 到分子精神醫學與轉譯精神醫學，未來無可避免的會進入所謂的精準精神醫學時代。隨著醫 學知識的演進，未來精神科醫師除了現有的臨床診斷外，將有更多的實驗室檢查，以幫助病 因的診斷。在治療方面除了根據病因進行相關的治療外，在開藥方面也會依據病人的基因資 訊，選擇療效最佳、副作用最少的藥物。這些臨床精神醫療行為的改變，當然也需醫院方面 進行結構的調整，組成跨領域團隊，才能落實。

Precision medicine is the next wave of big biomedical science in the United States of America, which will continue to lead the global biomedical research after the completion of the Human Genome Project. The arrival of precision medicine is first exemplified by the development of target therapy in cancer research. The knowledge and experiences gained from cancer research will be extended to another discipline of medicine according to the statement of the Precision Medicine Initiative. Psychiatry is a discipline of medicine; the big biomedical science will certainly have an influential impact on this field. The increasing knowledge of the medical conditions causing psychiatric symptoms and the availability of the whole genome information of the patients will transform the way that psychiatrists make a diagnosis and treat the patients. In the coming era of precision psychiatry, psychiatrists will have to order more laboratory tests including genetic tests to identify the etiology of psychiatric patients, and to tailor the treatment for each patient based on his or her genetic information. But the realization of the precision psychiatric practice needs support and change of the ecosystem or infrastructure of the clinical settings. This overview elaborates some examples of those progress in psychiatry that may transform the way we practice psychiatry to some extent shortly.