background Personalised psychiatry is the promise that biological stratification and analysis of ‘big’ data will enable clinical prediction.
aim To analyse promises and problems regarding personalised medicine in the psychiatry.
method Analysis of current challenges.
results Essential challenges are: 1. Biological psychiatry yields weak findings and clinically negligible diagnostic likelihood ratios. 2. The impact of biological stratification in medicine is relatively small yet may result in explosive health care costs. 3. Equivalent investment in public mental health may result in considerably higher health gains. 4. Data quality may be more important than data density. 5. The promise of biological stratification detracts from a hermeneutic approach and a focus on connectedness, meaning and identity.
conclusion Personal care with a focus on the unique narrative development and the non-linear process of enhancing resilience, in combination with within-person (n=1) predictive measurements (emotional, biological or other), may represent the best way to link the practice of psychiatry with the promise of personalised medicine.