Leo Sher, M.D.

Today, we publish an interview with an eminent psychiatrist, Dr. Shih-Ku Lin.

Shih-Ku Lin, M.D., is affiliated with the Department of Psychiatry, Lin-Kou Chang Gung Memorial Hospital, and Adjunct Professor, Chang Gung University, Taoyuan, Taiwan. Dr. Shih-Ku Lin is also Vice President of Asian College of Neuropsychopharmacology (AsCNP), Coordinator of the Consortium of Research on Asian Psychotropic Prescription Patterns (REAP), and a Member of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force on Men’s Mental Health.

Leo Sher: Do you believe biomarkers or pharmacogenomics will meaningfully change everyday prescribing practices in psychiatry, or are their clinical benefits currently overstated?

Shih-Ku Lin: Research into biomarkers for schizophrenia and other psychiatric disorders has seen limited success thus far. Currently, there are no biomarkers for diagnosis or medication efficacy available for use in routine clinical practice. Consequently, I do not believe the era of precision medicine for psychiatric disorders has arrived yet. Treatment remains largely based on clinical observation and judgment. Clinicians typically select medications to address specific target symptoms; if the initial treatment proves inadequate, they may switch to an alternative agent within the same class or transition to a different class entirely, utilizing either labeled indications or off-label applications. At present, although several commercial genotyping options are available for the CYP450 system, they are not particularly helpful in guiding everyday prescribing behavior. In clinical practice, we typically initiate treatment with a low dose and monitor for improvement in target symptoms. What is more essential is a thorough understanding of drug-drug interactions based on the specific pharmacological characteristics of each compound. For instance, fluvoxamine, a potent CYP1A2 inhibitor, can increase the plasma levels of clozapine twofold or more. Consequently, there is currently no routine clinical necessity to genotype psychiatric patients for the medications being prescribed.

Leo Sher: How will the development of artificial intelligence affect psychiatric practice and research?

Shih-Ku Lin: Currently, psychiatric diagnosis relies on clinical judgment and symptom checklists based on diagnostic criteria such as the DSM-5 or ICD-11. However, Artificial Intelligence (AI) is beginning to exert a burgeoning influence on the psychiatric field. Some research suggests that AI can enhance early detection and intervention for mental health conditions. Various studies have highlighted the effectiveness of AI-driven tools—such as chatbots and predictive modeling—in improving patient engagement and tailoring interventions. Nevertheless, these applications largely remain at the research stage and require further validation before being integrated into routine clinical practice.

In the near future, clinicians may encounter patients who arrive at the clinic with a psychiatric diagnosis already provided by an AI, even requesting specific medications they were ‘advised’ to take by these tools. Consequently, clinicians must become familiar with the capabilities and limitations of AI. This knowledge is essential for providing patients with a clear delineation between AI-generated suggestions and clinical reality regarding their specific concerns and symptoms.

From a research perspective, AI simulations can significantly accelerate drug discovery and development, particularly within the field of psychopharmacology. In the context of clinical trials, predictive modeling allows for the more efficient identification of suitable participants, real-time monitoring of treatment adherence, and earlier detection of both efficacy signals and adverse effects. Furthermore, AI facilitates the analysis of massive neuroimaging, genetic, and behavioral datasets, potentially uncovering novel biomarkers and biological pathways that underlie mental illness.

In conclusion, we are now living in the era of AI, which has permeated every aspect of our lives—from our professional work to our daily leisure activities. Just over twenty years ago, it was unimaginable that we would be able to communicate with someone far away via real-time video on a handheld screen, let alone receive highly informative answers from an AI chatbot. Given this rapid pace of change, it is difficult to even imagine what scenarios will define our daily lives twenty years from now.

Leo Sher: What advice would you offer to young psychiatrists and researchers who wish to make a meaningful and lasting contribution to the field?

Shih-Ku Lin: I believe that for young psychiatrists, beyond the essential training in psychotherapy, it is vital to keep pace with the latest advancements in psychopharmacology. Although recent years have seen the failure of several clinical trials targeting novel pharmacodynamic mechanisms for cognition or psychotic symptoms—such as Glycine Reuptake Inhibitors, PDE-9 and PDE-10 inhibitors, TAAR1 agonists, and NMDA modulators—these mechanisms nonetheless hold significant potential for the future of the field.

Interestingly, GLP-1 agonists, currently popular for treating diabetes and obesity, are now entering the realm of neuropsychiatry. They are being investigated not only to mitigate the metabolic side effects of antipsychotics but also for their potential as anti-craving agents and mood stabilizers. These complex mechanisms warrant more precise neurobiological study. In my generation, the monoamine system was essentially the only foundational knowledge to start with. However, today’s young psychiatrists must dedicate significantly more time to understanding these intricate brain processes and carrying out their own original research. Fortunately, information technology has advanced to the point where one can study anywhere and at any time. There is no longer a need to physically visit a library to manually search through journal archives. This digital accessibility has fundamentally transformed how we acquire knowledge and conduct research in modern psychiatry.