Precision Psychiatry Tools Move Toward Primary Care: RNA Biomarkers, Pharmacogenomics, and Digital Phenotyping

Original abstract

Mental disorders are common in primary care and impose substantial societal costs. Current psychiatric care still relies largely on trial-and-error prescribing, often delaying response and increasing adverse effects. Precision psychiatry aims to shift practice toward data-driven, individualized decisions by integrating biological markers, clinical phenotypes and contextual factors. This article introduces practical tools with an emphasis on real-world use in general practice: RNA-editing blood biomarkers (the EDIT-B test) to support the differentiation of bipolar disorder from unipolar major depression; genomic approaches targeting the AVP/V1B pathway as a proxy for HPA-axis hyperactivity and as a potential companion diagnostic for V1B-receptor antagonists; and pharmacogenomics (CYP2D6/CYP2C19) to guide antidepressant selection and dosing. Additional emerging components include inflammatory markers such as hsCRP, digital phenotyping with wearables for longitudinal monitoring, and metabolomic/lipidomic signatures for stratification. Finally, key implementation issues in primary care are discussed, including training needs, workflow and EHR integration, reimbursement, and data protection/informed consent.