The Same Medication Period for Everyone in Psychiatry is Over!

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Psychiatrist Prof. Dr. Stating that they use methods that include many screening methods such as neuropsychological screening, brain check-up and stress check-up, Nevzat Tarhan said, “There is a cost to do this, but the most expensive treatment is ineffective.

"Leaving a person without treatment is the most expensive treatment," he said. Saying "The post-genome era has begun," said Prof. Dr. Nevzat Tarhan said, “We are now inferring the truths we found with our medical experience with scientific evidence. "We are dealing with the medicine of the future," he said. Prof. Dr. Nevzat Tarhan said, “Having a medicine for everyone is not a suitable situation for this period anymore. That's why we care about personalized treatment. " said.

Üsküdar University Founding Rector, Psychiatrist Prof. Dr. Nevzat Tarhan pointed out the importance of sensitive medicine and personalized treatment at the multidisciplinary scientific training meeting held every week at the NPİSTANBUL Brain Hospital. Prof. Dr. Nevzat Tarhan gave examples from his studies in this field as a university and a hospital in his presentation titled “Precision Medicine, Personalized Treatment”.

We started personal therapy before the USA

Stating that the concept of "precision medicine" was announced by US President Barack Obama in 2015, Prof. Dr. Nevzat Tarhan said, “We also started personal treatment before 2015. We established a personal treatment center. Our starting point is this: Evidence-based medicine pyramid. We move from here. Studies and animal studies take place at the bottom of the evidence-based medicine pyramid. Outside the laboratory, there are results that emerge with ideas and opinions. Convictions arise with clinical facts. After clinical cases, laboratories come into play. Now a new field has emerged: In silico, the work done by computer or computer simulation, resulting in mathematical modeling on the computer. Computational psychiatry. In this study, also known as computational neuroscience, you get the person's data. According to this data, as the person such as the learning machine loads the information, it reveals possible options and consequences for you. The computer can give us a clue about diagnosis, something that people have learned in decades with mental wisdom and life experience. " he spoke.

Computers will diagnose in the coming periods

Stating that there will be very important developments in the coming period in line with the developments in technology and that computers will make the diagnosis in the coming periods, Prof. Dr. Nevzat Tarhan said, “We will enter the diagnosis, but I don't know what syndrome we can't even think of. quite a bit for him. zamWe'll have to waste a moment, but we're going to do medical records right now. We will write down our possible preliminary diagnoses. In it, the computer will reveal the possible diagnosis. This will become a routine in 10 years.” said.

Precision medicine: personalized treatment

Stating that the concept of personalized treatment is seen when it comes to the upper steps in the evidence-based medicine pyramid, Prof. Dr. Nevzat Tarhan said, “As we climb up the steps below, single case series are formed. Later, case-control studies, randomized-controlled studies, randomized-controlled double-task studies and meta-analyzes now emerge at this stage. These are studies with the highest level of evidence. These studies are now studies with the highest level of evidence. These are studies that we will summarize as personalized treatment called "sensitive medicine" in Turkish. " said.

Leaving a person untreated is the most expensive treatment

"There is a cost to do this, but the most expensive treatment is ineffective," said Prof. Dr. Nevzat Tarhan said, “We are doing neuro-psychological screening. We're doing a brain check-up. We do stress check-up. We do a lot of scans. Some colleagues say it's too expensive, but we're not the first step. We are a tertiary hospital, not a secondary one. In the first step, treatment is done at minimum. In the second step, the treatment is done optimally. The third step is done at the maximum. Leaving a person untreated is the most expensive treatment. You are giving people a lost life. For this reason, we need to treat them to the maximum in our target areas in our position for their treatment. " said.

Therapeutic alliance with the patient has a placebo effect

Emphasizing the importance of correct communication between the mental health worker and the patient, Prof. Dr. Nevzat Tarhan said, “There is a metaphor we use in treatment: If the mental health worker and the patient work together for the patient's well-being, an alliance is formed. The therapeutic relationship starts from the first meeting of the healthcare worker and the patient. From the moment the patient enters the room, meeting him standing up and leaving him standing, all these are therapeutic relationships. This therapeutic alliance, a neurophysiological event, has a placebo effect. This brings out the binding. It creates a secure bond between the patient and the physician. Secure attachment has a 40% placebo effect because it reveals secure attachment. 40% of the treatment is a trust relationship. zamYou are gaining the moment. The relationship of trust between the patient, the physician and the healthcare worker is very important in the permanence of the treatment. In other words, not everything is robotization in precision therapy.” he said.

Pharmacogenetics and personal medicine entered our mission

Referring to the difference in their vision and missions as Üsküdar University and NPİSTANBUL Brain Hospital, Prof. Dr. Nevzat Tarhan said, “The vision is for a person to imagine and document things that can happen. The mission is to imagine and document the things he can do. That's why we clarified our mission and vision. Some of these exist as a vision. This is a vision prediction. Pharmacogenetics and personal medicine have now entered our mission. " said.

Pointing out the importance of the search for biological evidence, Prof. Dr. Nevzat Tarhan, “What kind of organ is our brain? It's not just a chemical organ. Our brain is not just an electrical organ. An electromagnetic organ. Wherever there is a source of electricity, there is also a magnetic field. For him, it is an organ with a close causal relationship in the quantum universe. Human is a relational being. " said.

As physicians, we are like tailors, not garments.

Emphasizing that the human brain is a digital entity and the brain database is important, Prof. Dr. Nevzat Tarhan said, “If we can manage this database, information technologies and our database, information technologies are important here. As physicians, we are no longer like tailors, we are not garments. This is the essence of medicine. Not every doctor treats like a garment. He treats like a tailor. For him, there is a concept of individual treatment. " he spoke.

Noting that the evidence will increase as studies are carried out on depression and bipolar by carrying out some scientific studies under ethical conditions. Dr. Nevzat Tarhan said, “The important thing is that we can present accurate information to the scientific flow. The second important step in neuropsychiatry is drug blood level determination. Preliminary diagnosis of this genetic polymorphism. This is more personal than genetic profiling. Genetic profiling gives personal findings, but here you are phenotyping. O genotyping, that's phenotyping. You are looking at the person's gene function and gene expression. What does this person's gene expression do? Fast metabolizer or slow metabolizer? You can detect that. " said.

The right medicine, the right dose, the right way

Emphasizing that the principle of "the right medicine, the right dose, the right way" is very important in precision medicine, Prof. Dr. Nevzat Tarhan said, “This is the pharmacogenetic aspect of personalized treatment. Here you give the pill, people are affected differently. While you get 10 mg a lot for one person, it doesn't affect the other person even though you give a lot more. It is important to be able to make this choice. In terms of safety and effectiveness, a personalized treatment approach is required. Toxicity is also important. Apart from safety, it is also toxic in terms of safety. Whether it benefits the patient or not and allows us to distinguish these groups. In terms of treatment response, it shows that the normal dose, low dose or high dose responds to the person. said.

The post-genome era has begun

Prof. Dr. Nevzat Tarhan said: “The aim of the precision medicine approach is to teach the method of making the scientific clinic scientifically and the method of disseminating it. Otherwise, people are walking door to door, doctor by doctor. I see this as the scientific proof of our success. That's why the post-genome era has begun. The drug is to monitor blood levels and clinical effects. The future of personalized treatment is very important even in autoimmune diseases. You use genetic testing using various methods. You use technology, you can classify drugs according to groups using various imaging methods. This is the medicine of the future. More personal diagnosis. Having a medicine for everyone is no longer a suitable situation for this period. That's why we care about personalized treatment. We have a pharmacogenetic identity in treatment. Drug blood level preliminary study of the person's genetic polymorphism. It increases the effect of the treatment. It increases the safety of the treatment. It increases the therapeutic effect and reduces its cost. The most expensive treatment is ineffective treatment. It is important to find many correct ways and methods with just one medicine.

We are dealing with the medicine of the future, not the town medicine ...

Noting that medicine has three pillars, Prof. Dr. Nevzat Tarhan, “Genetics, neural network and neuro technology in the brain. NASA employs over 2 doctoral students in neuroscience. The concept of neurolink came out. Elon Musk is now the richest man in the world and worshiped the dream business. We are dealing with the medicine of the future, we are not dealing with town medicine, ”he said.

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