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August 2013

The Neuropsychiatric Translational Revolution: Still Very Early and Still Very Challenging

Author Affiliations
  • 1Department of Anthropology, School of Medicine, University of California, San Diego, La Jolla
  • 2Department of Psychiatry, University of California, San Diego, La Jolla
  • 3VISN 22, Mental Illness Research, Education, and Clinical Center (MIRECC), VA San Diego Healthcare System, San Diego, California
JAMA Psychiatry. 2013;70(8):777-779. doi:10.1001/jamapsychiatry.2013.2184

Advances in knowledge of mammalian neurobiology and genomics far outpace their application to common but complex human disorders, especially those impacting brain function. Recently, Karayiorgou et al1 argued for the almost exclusive use and funding of neuropsychiatric research using highly penetrant de novo mutations and selected animal models to illuminate the neural circuit and genomic network basis of neuropsychiatric disorders and to get Big Pharma back into central nervous system drug development. While their viewpoint reflects the great speed with which knowledge about mammalian genomics and neurobiology is proceeding, the translation of this kind of new basic science data to the bedside is proceeding at a much slower pace, making such prescriptive scientific pathways premature.2 Many therapeutic advances in medicine are concentrated in accessible tissue disorders, such as coagulopathies and oncology, where diseased tissue can be directly examined and manipulated. But we largely lack such direct approaches for the relatively inaccessible brain with its complex neural circuit imbalances compared with the more discrete mitotic dysfunctions seen in oncology. Furthermore, with an increasing basic science and genomic focus in psychiatric neuroscience, we often overlook treatment advances in the area of cognitive, psychosocial, and health services interventions, either alone or in conjunction with pharmacotherapies.3 To suggest that one translational approach to complex neuropsychiatric disorders be given almost absolute scientific and funding primacy1 is very premature indeed.