Personalizing mental health care

To best illustrate what precision medicine is and why it is the future of research and care at CAMH, let’s take a brief look at how imprecise the state of treatment for youth mental illness can be.

We know from previous research that 75 per cent of youth who go on to develop psychosis had sought mental health treatment in the previous three years. But only five per cent of them showed any overt symptoms of psychosis before it emerged. Are there signs and symptoms that can be detected early enough, if we only knew what they were, that would make possible more personalized and effective treatments that could stop serious mental illness before it starts? Can we actually prevent psychosis?

According to Dr. Aristotle Voineskos, Vice President, Research at CAMH and one of the many investigators for the Toronto Adolescent & Youth (TAY) Cohort Study, the answer is a resounding “yes.”

“There are few clinical trials involving children and youth—treatments were historically extrapolated from adult trials,” says Dr. Voineskos. “Large cohorts provide an opportunity for clinical trials, and more importantly to both hone in on specific subgroups who may be at risk, while also studying enough people to ensure results are generalizable and relevant to different communities. I believe a clinical trial network devoted exclusively to children and youth mental health would be the first of its kind in the world. While there are several international cohort studies, they are typically following kids from the general population; ours is unique in its focus on those seeking mental health care.”

While full results of the study are still a few years away, Dr. Voineskos says the early data is already making an impact on patient care.

“We are already seeing data that can change practice now. Clinicians used to think psychosis was rare. And this is partly true in relation to a full-blown psychotic episode. But our early data in the first 300 patients show that nearly half of youth seeking mental health care at CAMH experience psychosis spectrum symptoms. We did not know this before,” says Dr. Voineskos.

“Whether it is child and youth or patients of any age, we can build a much more complete picture of each individual, not just in the clinic, but outside as well with wearable devices that can track sleep and other functions. Then we can build a predictive model to give them the best personalized care. For example, we could better determine which young person with depression, based on a combination of mitochondrial deficiency, brain inflammation and a sleep disorder, might then require a combination of drug and behavioural therapy. Not only have we successfully treated their depression, but we might have prevented another mental illness from occurring later in adolescence, such as psychosis. That would be ground-breaking.”

All of this promise for transformational change in the way mental illness is diagnosed and treated is why Dr. Voineskos believes that public support for a new Research & Discovery Centre at CAMH is so vital.

“Science is an international pursuit and CAMH attracts scientists from around the world. A new Research & Discovery Centre with state-of-the-art facilities will allow us to attract even more by an order of magnitude,” says Dr. Voineskos. “The symbolism of it is important, too. Mental health is the greatest cause of our time and we need an investment commensurate with the scale of the problems we are trying to solve. We want people to walk by our campus and say ‘Wow! This is where ground-breaking research is happening in an extraordinary facility that exists to tackle challenges that almost everyone in our community faces.’”