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

 / Dr. Chiara Fabbri

Dr. Chiara Fabbri

WP2 leader, UNIBO

Dr. Chiara Fabbri is a psychiatrist and researcher, focusing on genetic factors influencing psychotropic drug response and mood disorder heterogeneity.

What keeps me motivated is the desire to contribute to the advancement of scientific knowledge and healthcare in a field of medicine that, I believe, is still poorly understood compared to others.

You could’ve been anything — a painter, a chef, an engineer . What made you choose to become a psychiatrist and researcher, and what keeps you excited about it?

This choice felt more like a vocation than a decision stemming from rational thinking. I don’t want to lie about this; it is a very demanding job, and it may take a lot of time and effort to achieve what seems like a small step forward. Being a psychiatrist as well, I am confronted with everyday issues that we face in the clinic. What keeps me motivated is the desire to contribute to the advancement of scientific knowledge and healthcare in a field of medicine that, I believe, is still poorly understood compared to others.

You’re mixing biological markers, computer science, and real patient data. What’s the most interesting finding so far?

I find it exhilarating to uncover findings that could potentially impact clinical practice in the future. For instance, the discovery that certain symptoms of depression are associated with specific genetic markers not only aids in personalising treatment prescriptions but also facilitates the development of medications targeting the specific biological mechanisms present in individuals exhibiting those profiles, as opposed to treating based on a general psychiatric diagnosis.

You’re working on making treatments more personal. Can you give us a sneak peek of how this could change the way we treat mental health in the future?

Building on my previous answer, biomarkers like genetic variants can be tied to the biological mechanisms accounting for the differences among individuals with the same psychiatric disorder. The most pertinent differences are those significant for patients’ wellbeing and recovery, such as specific symptom profiles associated with either a response or resistance to treatment. By understanding the biological mechanisms underlying these crucial differences, clinicians can leverage the corresponding biomarkers and associated symptom patterns to inform therapeutic choices, identifying patients who may require specific treatments, thereby moving away from a trial-and-error approach.

Your work helps us understand why some people’s treatments don’t work. Could this lead to entirely new approaches in medicine?

I hope that this insight can lead to new approaches in psychiatry. The biological mechanisms underlying treatment resistance are better comprehended in other medical fields, where treatments are already considerably more personalised. I believe the potential revolution lies not only in prescribing treatments in a more personalised manner but also in developing new treatments similarly tailored to individual needs. If we identify biomarkers associated with specific forms of treatment resistance, this discovery could serve as a launching pad for developing new treatments targeted at these particular issues. This could also shift the paradigm towards treatments that are not only more effective but also act more swiftly.

You’re leading Work Package 2 of the Psych-STRATA project. How does your work fit into the bigger picture of this project?

In this work package, we examine the protein levels in patients’ blood as biomarkers of treatment response. Proteins, being the final products of genes, inform us about the occurrences at the termination of a chain of biological processes. Protein levels are influenced not only by genetic differences among individuals but also by other factors, such as environmental elements to which our bodies react. In this work package, we investigate how genetic variants affect treatment response by regulating protein levels. Additionally, we can identify differences in protein levels between responders and resistant patients that are not linked to genetic variants, suggesting the presence of other regulatory mechanisms.

Do you have a hobby or some activity you enjoy doing in your free time, tell us about it?

I enjoy sport in the nature, particularly mountain biking and swimming in the sea. It helps my mind relax and forget about the everyday problems for a bit, as well as having new ideas and be more creative.

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