Conceptual endophenotypes: A new bridgehead from the bedside

Several strategies have been developed to bridge the gap between bench and bedside to establish precision medicine. The bridgehead recently launched by the NIMH is represented by the Research Domain Criteria (RDoC) and data mining. The RDoC framework is based on basic research data, intending to stepwise develop data driven systems or dimensions, integrating information from different sources, which may allow prospective replication and finally lead to better 'stratified' clinical trials. However, this strategy faces numerous challenges at the bedside, ranging from proof of clinical relevance and cost-benefits to implementation in national healthcare systems. Here we introduce a complementary strategy, with a bridgehead at the bedside, the other side of the RDoC bridgehead. Our approach (Neuropatterntm NP) is based on conceptual endophenotypes of the stress response network. NP is a diagnostic tool, that discriminates 13 conceptual endophenotypes. We have already found that NP is capable of reducing the intangible, tangible, and direct costs in the treatment of stress related disorders. In addition, NP turns out to be a valuable research tool, since associations of gene variants with patterns seem to be more striking than with either symptoms or diagnoses. We conclude that both bridgeheads will be useful assets to develop a stratified medicine of mental disorders.