Personalized treatment with atypical antipsychotic medications.
The considerable pharmacologic differences among atypical antipsychotic agents and the specific clinical circumstances of individual patients with psychiatric illness require the availability of a full range of agents in this class. Restrictions in the availability of atypical agents may prove to be counterproductive, both clinically and economically. Elderly individuals and those from minority groups may be particularly disadvantaged by restrictions placed on these agents. Additional clinical studies in large populations with different forms of schizophrenia and varied clinical histories are required to determine the appropriateness of specific atypical agents in patient subgroups. Advances in knowledge of the molecular genetics of schizophrenia and the receptor properties of individual drugs will help the clinician determine which drug and dosage are best for each individual patient. This will eventually replace the "hit or miss" process that characterizes current practice. Because of variations in response to atypical agents, the clinical vulnerability of patients with psychiatric illness, the difficulties they have in adapting to changes and adhering to medication regimens, and our poor understanding of the molecular basis of schizophrenia and its treatment, prescription insurance plans should provide access to a broad range of atypical agents.
Kim
Edward
E
Associate Director, Outcomes Research USA, Global Epidemiology and Outcomes Research, Bristol-Myers Squibb Company, Plainsboro, New Jersey, USA.
Levy
Richard
R
Pikalov
Andrei
A
D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics / Q000378:metabolism; D051544:Cytochrome P-450 CYP3A; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics / Q000378:metabolism; D004347:Drug Interactions; D005569:Formularies as Topic; D014644:Genetic Variation; D005853:Geriatrics; D006801:Humans; D007343:Insurance Carriers; D008913:Minority Groups; D010349:Patient Compliance; D010597:Pharmacogenetics; D012559:Schizophrenia / Q000188:drug therapy* / Q000378:metabolism
D014150:Antipsychotic Agents; D003577:Cytochrome P-450 Enzyme System; D019389:Cytochrome P-450 CYP2D6; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human