A Clinician’s Perspective on Biomarkers

• Published in: Focus (American Psychiatric Publishing) Vol. 16; no. 2; pp. 124 - 134
• Main Authors: Rush, A. John, Ibrahim, Hicham M
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01.04.2018
• Subjects: Reviews; treatment selection; prognostication. diagnosis; psychiatry; biomarker; bio-measures
• ISSN: 1541-4094; 1541-4108
• DOI: 10.1176/appi.focus.20170044

Use of biomarkers to diagnose, predict the prognosis of, and guide the treatment of neuropsychiatric conditions is in its infancy. However, the era of biomarkers is upon us. This article provides an overview of biomarkers, their clinical uses, and challenges in their development and use. Psychiatrists and mental health professionals regularly perform various clinical tasks (e.g., detection, differential diagnosis, prognostication, treatment selection and implementation). How well they perform each of these tasks has a direct impact on patient outcomes. Measurement-based care has brought greater precision to these tasks and has improved outcomes. This article provides an overview of the types of biomeasures and biomarkers, the clinical uses of biomarkers, and the challenges in their development and clinical use. Although still in their infancy, biomarkers hold the promise of bringing even greater precision and even better outcomes in mental health. Biomeasures that could become biomarkers include genetic, proteomic, metabolomic, and immunologic measures, as well as physiological, functional, and brain structural measures. Mechanistic markers reflect and are based on the specific pathobiological processes that are involved in the development of a clinically defined condition. Some clinically relevant biomarkers may rely on this mechanistic understanding while others may not. Clinical biomarkers serve three broadly defined goals. Diagnostic markers define what is wrong. Prognostic markers define what will happen in the natural course of the condition, although they may also predict the course of illness during treatment. Theranostic markers address issues pertinent to treatment by defining whether, when, whom, and how to treat. Other biomarkers may be used to monitor the overall effect of treatment regardless of the therapeutic effects or to monitor the specific therapeutic effects of the intervention on the disorder itself. Biomarkers can also be used to estimate susceptibility/risk of developing the condition or the biological consequences of having had the disorder.