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8atric disorders share common pathological mecha-nisms, and prompt us to rethink the current disease concepts in psychiatry.Researchers have started a new approach, the “genotype-first approach,” to resolve this issue 69-73). The genotype-first approach is a research strategy to associate a specific genotype to a broad range of clinical phenotypes, not limited to conventional psychiatric symptoms but including somatic and physiological signs74, 75). Traditional genetic research has adopted the opposite approach, the “pheno-type-first approach,” which is a research strategy to associate a specific phenotype to genotypes. The genotype-first approach is essentially free from the current nosology of psychiatric disorders. This approach has begun to characterize the individuals with the established risk variants significantly affecting the onset of psychiatric disorders76-80). Starting from the traditional diagnosis and genomic analysis, the researchers characterize the individ-uals with extensive medical evaluations including physical and physiological examinations to explore Figure 3　A schematic illustration of the genotype-first approach in our department (Department of Psychiatry, Faculty of Medicine, Juntendo University). The copyright-free images of clinical tests are derived from Pixabay (https://pixabay.com/). The historical image of the Juntendo clinic is derived with permission from Gakko-hojin Juntendo.the genotype-phenotype correlation (Figure 3). The question is how much the genotype-first approach effectively characterizes possible disease concepts in a wide range of psychiatric disorders. Some clinicians have begun to feedback genetic information of such risk variants to the patients regardless of conventional psychiatric diagnosis81). This approach will benefit future psychiatric research, but the answer will be evident through our effort with this genotype-first approach.I thank all the members of the Department of Psychiatry, Faculty of Medicine, Juntendo Univer-sity, for valuable discussion and clinical insight for this review.This work was partly supported by AMED under Grant Number JP20dm0307028 (Strategic International Brain Science Research Promotion Program [Brain/MINDS Beyond] for M.N.), and AcknowledgementsFunding