A Stratified Treatment Algorithm in Psychiatry: A program on stratified pharmacogenomics in severe mental illness

 / Prof. Bernhard Baune

Prof. Bernhard Baune

(PhD, MD, MPH, FRANZCP), Coordinator, WWU

A distinguished psychiatrist and neurobiology researcher and currently serves as the Head of the Department of Psychiatry at the University of Münster.

Psych-STRATA will become a reference project with its data and experience for future researchers and patients.

We’d love to get to know you a bit better! When you’re not working, what activities or hobbies bring you joy? And could you share what sparked your interest in this career path?

In my spare time I enjoy spending time with family, being active and enjoying outdoor activities.  When I have more spare time to spend, I enjoy travelling and hiking. My interest in a career path in Psychiatry was sparked through the realisation of the central importance of the human brain and mind for all dimensions of life and well-being. Being in the position to understand the human brain and mind and mental illness through research and clinical practice has deepened my interest and fascination in my career path in Psychiatry. No other medical discipline requires and fosters the same intensity of interdisciplinarity in both clinical practice and research as Psychiatry does.

Could you walk us through the inception of Psych-STRATA—how did the idea first take shape in your mind? and how the project hopes to revolutionise the field of psychiatry?

Several years ago, I expressed the idea while talking to a colleague at a conference that there is a great scientific and clinical need to better understand the biological underpinnings of and to prevent treatment-resistant depression and that it would require a concerted international effort bringing together the best minds in the field to make a significant impact in the field and to patients.

Some years later, the recent Horizon Europe funding scheme seemed to exactly ask for such a research endeavour with potential for translational impact. I felt this was the right call to submit my idea to, together with the best available team of researchers, clinicians and patient advocates in Europe and beyond. Hence, I developed the key idea of putting together the Psych-STRATA consortium which is to identify and treat people at high risk for severe mental illness as early and as effectively as possible to prevent unnecessary suffering, poor course of illness and poor quality of life in the long-term. We decided to carry out this research on treatment-resistant depression, bipolar disorder and schizophrenia.

Blood-based molecular markers may carry the biological information of such an increased risk of developing severe mental illness long before the illness shows clinical signs and symptoms and long before changes in brain imaging can be found. Another advantage of blood-based biomarkers is that they have easy accessibility through small amounts of blood and they provide rich biological information.

Psych-STRATA aims to develop for the first time a comprehensive prediction tool consisting of a blood-based test jointly with digital and clinical information of individual patients that will help identify and then treat patients at risk for severe mental illness. Psych-STRATA will become a reference consortium with its data and experience for future researchers and patients. Through the work in Psych-STRATA, it is envisioned that in future, patients will be able to contact expert centres that will be able to assess the risk for treatment resistance for individual patients and to offer advice on adequate treatments and prevention that help avoid the development of a treatment-resistant mental health condition.

As a pioneer in the field of personalised medicine for psychiatric disorders, how do you envision the future of treatment in this area?

I envision that in future, a predisposition to treatment resistance and severe mental illness will be discovered early and adequate and effective treatments will be made available to patients much earlier than today.

I envision that the current stepwise and “wait and see” approach will make room for early detection and early intensified treatments for this at-risk population. I envision that we will develop novel mental health boards where patients can be referred to for an assessment of their risk for treatment resistance and where they can seek advice for adequate effective and early treatments.

Such mental health boards will consist of expert clinicians and researchers that have the capacity to utilise and interpret comprehensive multimodal individual-level patient data for the benefit of single patients.

It is envisioned that Psych-STRATA will become the prime reference database for this. The knowledge and expertise generated by the Psych-STRATA consortium shall become the foundation for the translation into personalised detection and early treatment for people at risk for treatment resistance.

Over 660 peer-reviewed articles, reviews, and book chapters bear your name. Is there a particular piece of research or a specific publication you’re most proud of, and why? 

Publications that carry have a translational impact on patient care are the most important ones. Several of my publications that investigate molecular underpinnings of treatment response in mental health conditions show the strongest potential impact on future patient care (e.g. PMID: 29121268). In addition, I am proud of the first book on Personalised Psychiatry (Publisher Elsevier) in the field that I was able to edit and put together with world-leading experts ranging from psychiatrists, neuroscientists, psychologists, and economists to health service researchers. This is the most comprehensive book in the field and people find it a great reference for the state-of-the-art. Most importantly, these publications are the result of great networking efforts across a large number of experts and leaders in their respective fields. I am most proud to be able to lead several of these research consortia in psychiatry that aim for making a difference to patients while producing excellent research results.

Psych-STRATA is focused on personalised treatments for major psychiatric disorders. Could you share a success story or an instance where this personalised approach significantly improved a patient’s quality of life?

Based on my daily experience from clinical practice when treating patients with very severe mental conditions, I am aware that only a personalised approach carries the chance of treating them effectively despite the severe condition.

Patients may return to their previous standard of living. Just recently, a mid-fifty-year-old female patient with severe treatment-resistant depression reported that she hasn’t been feeling as good as after a full treatment cycle in our centre in more than 30 years despite the severe condition.

Another example is a 64 years old male patient with bipolar disorder, who reported – following a very intense treatment regimen for bipolar disorder in our centre – that he feels back to his normal self, can function normally and follow his passion as an artist. These examples demonstrate that personalised approaches do work in many patients who already suffer from treatment resistance.

The next frontier of research and clinical translation will be to identify these patients early, before they become treatment resistant, to treat them more intensively early, thereby achieving better clinical outcomes, avoiding the development of treatment resistance and maintaining a higher quality of life.

Is there something else you think the Psych-STRATA audience should know about the project? Especially mental health patients.

To progress treatments for mental health patients, it is very important to enable conditions and environments in which patients will be able to engage, feel self-empowered and develop resilience and practise self-efficacious interventions. There is much to learn and develop on patient-oriented outcomes. A crucial part of patient-focused outcomes is giving patients the chance to interact with healthcare professionals and make decisions together regarding their diagnosis and treatment. This is a significant focus for the Psych-STRATA consortium.

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