Personalized pharmacotherapy in psychiatry.
The hypothesis of each individual being special and different leading to heterogenity of diseases sets the ground for the concept of personalized medicine. Personalized psychiatry follows the principles of personalized medicine. A constituent part of an individually adapted approach towards the psychiatric patient presents itself thorough personalized psychiatry. The development of pharmacogenomics and pharmacogenetics as well as the nanotechnology based on them ensures implementation of personalized medicine principles in psychiatry to a greater extent than other medical disciplines. In the field of pharmacogenomics, the greatest advance was achieved by the study of genetic variability in drug metabolism. All the predispositions are now present for the implementation of pharmacogenetic tests in routine practice. Pharmacogenetic testing for medications which are metabolised thorough two polymorph cytochromes P 450: CYP2D6 and CYP2C19 is of special significance due to their involvement in most adverse and ultrafast metabolism of psychopharmacs. The potential application of personalized medicine in psychiatry, supported by pharmacogenetics and pharmacogenomics, are: personalized medication choice, personalized dosage, anticipation of possible side-effects individually and personalized follow-up treatment with rehabilitation. The authors conclude how the development of pharmacogenomics and pharmacogenetics as well as the nanotechnology based on them, presents a step forward in creating a personalized therapeutic approach in psychiatry. However, the burden of applying the most appropriate therapeutic agent and medication tapering remains based on clinician decision. Pharmacogenetics can only help by making therapeutic decisions with one less unknown element.
University Department of Psychiatry, Clinical Hospital Osijek, Osijek, Croatia. filakovic.pavo@kbo.hr
Pavo
P
Filaković
Anamarija
A
Petek
D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D065731:Cytochrome P-450 CYP2C19; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics; D054796:Drug Dosage Calculations; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D001523:Mental Disorders / Q000188:drug therapy* / Q000235:genetics*; D036103:Nanotechnology / Q000639:trends; D010597:Pharmacogenetics / Q000639:trends*; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*
D011619:Psychotropic Drugs; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D019389:Cytochrome P-450 CYP2D6