title: Personalized medicine in psychiatry: new technologies and approaches.
abstract: Psychiatric patients tend to exhibit significant interindividual variability in their responses to psychoactive drugs, as well as an irregular clinical course. For these (and other) reasons, increasing numbers of psychiatrists are turning to genotyping for help in selecting the psychopharmacologic agents best suited to an individual patient's distinctive metabolic characteristics and clinical presentation. Fortunately, routine genotyping is already available for gene variations that code for proteins involved in neurotransmission, and for drug-metabolizing enzymes involved in the elimination of many medications. Thus, genotyping-based personalized psychiatry is now in sight. Increasing numbers of clinically useful DNA microarrays are in the development stage, including a simplified procedure for genotyping patients for CYP2D6, which metabolizes a high proportion of the currently prescribed antidepressants and antipsychotics. It has been pointed out that psychiatric disease is rarely a consequence of an abnormality in a single gene, but reflects the perturbations of complex intracellular networks in the brain. Thus, analysis of functional neuronal networks is becoming an essential component of drug development strategies. The integrated use of technologies such as electroencephalography, magnetoencephalography, functional magnetic resonance imaging (fMRI), and diffusion tensor imaging (DTI), in combination with pharmacogenetics, promises to transform our understanding of the mechanisms of psychiatric disorders and their treatment. The concept of network medicine envisions a time to come when drugs will be used to target a neural network rather than simply components within the network. Personalized medicine in psychiatry is still at an early stage, but it has a very promising future.
authors.affiliation: Brazilian Brain Institute, Rua Getúlio das Neves, 22, 22461-210 Rio de Janeiro, RJ - Brazil. jacs@inbracer.com.br
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Costa e Silva
mesh_terms: D000928:Antidepressive Agents / Q000378:metabolism / Q000493:pharmacokinetics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000378:metabolism / Q000493:pharmacokinetics / Q000627:therapeutic use; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics; D003577:Cytochrome P-450 Enzyme System / Q000235:genetics; D056915:DNA Copy Number Variations; D056324:Diffusion Tensor Imaging; D004569:Electroencephalography; D005838:Genotype; D006624:Hippocampus / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D008279:Magnetic Resonance Imaging; D015225:Magnetoencephalography; D001523:Mental Disorders / Q000175:diagnosis* / Q000188:drug therapy / Q000235:genetics* / Q000503:physiopathology; D009415:Nerve Net / Q000503:physiopathology; D059906:Neuroimaging / Q000379:methods; D010597:Pharmacogenetics / Q000379:methods / Q000639:trends; D011110:Polymorphism, Genetic; D049268:Positron-Emission Tomography; D057285:Precision Medicine / Q000379:methods / Q000639:trends; D017397:Prefrontal Cortex / Q000187:drug effects / Q000378:metabolism; D011570:Psychiatry / Q000379:methods* / Q000639:trends*; D011619:Psychotropic Drugs / Q000378:metabolism / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs; D003577:Cytochrome P-450 Enzyme System; D019389:Cytochrome P-450 CYP2D6