This Special Communication evaluates the potential roles of genomic information — specifically polygenic scores (PGSs) and rare variants — in guiding preventive strategies across the spectrum of psychiatric care, from universal primary prevention to secondary and tertiary prevention.
Population-wide genomic screening is not currently supported by evidence of net clinical benefit due to modest absolute risk differences and limited individual-level predictive accuracy; however, targeted use of rare variant testing in early psychiatric care (before diagnoses crystallize) and pharmacogenomics in secondary/tertiary prevention offer the most actionable near-term value.
As a Special Communication (expert narrative review), it does not present primary data or systematic evidence synthesis, limiting the strength of its recommendations. No quantitative effect sizes or clinical outcome data from trials are reported.
Do not use genomic testing for population-wide psychiatric screening. Consider rare variant testing in patients with early, diagnostically uncertain presentations within the psychiatric treatment system, and apply pharmacogenomics to guide medication choice and safety in established illness.
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