Abstract
Mental illnesses are not confined to behavioural and cognitive systems, but bodily ones as well. The extent of this involvement seems significant, spanning physiological systems and perhaps even being causally involved in psychiatric symptoms (Lasselin et al., 2021; Mohanan and Maselko, 2010). These somatic findings are not only a consequence but a feature of, many common mental disorders. In addition, they do not come without consequences, either. Together with behavioural risk factors, these bodily states may be mechanistically driving the disproportionately high rates of premature death, chronic illness, and overall accelerated ageing in mentally ill populations (Momen et al., 2022; Wertz et al., 2021). As a result of the relative neglect of biological rehabilitation in treatment outcomes, it is currently unknown which, and whether, any current treatments improve these disproportionate morbidity and mortality burdens. Limited evidence suggests that effective depression treatment might not improve cardiometabolic risk factors (Carney et al., 2024), and on the contrary, that effective antipsychotic usage might aggravate these cardiometabolic risks leading to insulin resistance and obesity (Pillinger et al., 2020).
Going back to the core goal of biological rehabilitation, centering the broader somatic dysregulation can help achieve a more proactive and preventative course of treatment. First, directly intervening on these systematic features at the point of care might proactively improve psychiatric symptoms. Second, treating associated chronic illnesses at the point of care – and therefore, restoring functional health – might help prevent the development of more severe comorbidities, and consequently, psychiatric treatment relapse (Yang et al., 2020).
While biological rehabilitation is a broader goal, it can be best studied and examined through a precision medicine lens as these somatic dysfunctions might be more specific to transdiagnostic domains (i.e. common features across mental disorders, such as anhedonia) or disease sub-phenotypes (i.e. only a smaller subset of patients within a condition, such as immunometabolic depression within major depression). These are areas that precision psychiatry is best equipped to handle, but these approaches remain to be systematically integrated with other biological domains relevant to disease and disability. Such a pursuit should include large-scale trials with ‘rehabilitation’ endpoints (see Figure 1 for examples) spanning from clinically validated (e.g. cardiometabolic risk panel) and next-generation biomarkers that capture global morbidity and mortality risks (e.g. neuroimaging and epigenetic clocks). In basic science research, focus should be given to the commonalities in polygenic risk scores to identify shared vulnerabilities and druggable pathways and to the brain-based mechanisms underlying neurodegenerative features in mental illness. Only then will we know which, or whether, psychiatric treatments can simultaneously, or independently, improve these critical functional outcomes. In addition, this aim should address some of the known issues with primary outcomes in psychiatric treatment trials: for example, researchers have argued that typical primary outcomes in neuromodulation trials for depression might fail to capture ‘true’ signals of efficacy, which could be identified using quality-of-life metrics or specific goal-setting (Rabin et al., 2020).
Putative rehabilitative endpoints that might indicate resilience against disease and better prognostic outcomes in psychiatric patients.
Until these frameworks are fully developed, clinicians can take immediate steps to bridge the gap. Routine screening for clinically validated disease markers might help identify systemic risks early, allowing for interventions at the point of care. More interesting, next-generation tools are also freely available online to more sophisticated risk stratification; notably, the National Health Service (NHS) makes its ‘Heart Age’ risk calculator available to all: https://www.nhs.uk/health-assessment-tools/calculate-your-heart-age. In addition, incorporating lifestyle interventions, such as exercise therapy or a Mediterranean-style diet, could serve this dual therapeutic goal at a very low risk (Walburg et al., 2023). These measures might also reduce delays in treatment and improve cohesion between psychiatric and medical care. However, more importantly, they represent factors that could improve prognostic outcomes beyond current standards of care.
Precision psychiatry must evolve beyond simply predicting symptom management and clinical phenotyping. By embracing biological rehabilitation and the broader mind–body dyad, this burgeoning field can address the systemic dysfunctions that perpetuate suffering, disability, relapse, and premature mortality. Only then can we fully realise psychiatry’s promise as a discipline that restores long-term health and happiness.
Footnotes
Declaration of conflicting interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
