title: Role of Pharmacogenetics in Improving the Safety of Psychiatric Care by Predicting the Potential Risks of Mania in CYP2D6 Poor Metabolizers Diagnosed With Bipolar Disorder.
abstract: One of the main concerns in psychiatric care is safety related to drug management. Pharmacogenetics provides an important tool to assess causes that may have contributed the adverse events during psychiatric therapy. This study illustrates the potential of pharmacogenetics to identify those patients for which pharmacogenetic-guided therapy could be appropriate. It aimed to investigate CYP2D6 genotype in our psychiatric population to assess the value of introducing pharmacogenetics as a primary improvement for predicting side effects.A broad series of 224 psychiatric patients comprising psychotic disorders, depressive disturbances, bipolar disorders, and anxiety disorders was included. The patients were genotyped with the AmpliChip CYP450 Test to analyzing 33 allelic variants of the CYP2D6 gene.All bipolar patients with poor metabolizer status showed maniac switching when CYP2D6 substrates such as selective serotonin reuptake inhibitors were prescribed. No specific patterns were identified for adverse events for other disorders.We propose to utilize pharmacogenetic testing as an intervention to aid in the identification of patients who are at risk of developing affective switching in bipolar disorder treated with selective serotonin reuptake inhibitors, CYP2D6 substrates, and inhibitors.
authors.affiliation: From the Servicio de Psiquiatría, Hospital Universitario de Salamanca (SS-I, CL-R, TM-P); Instituto Biosanitario de Salamanca, IBSAL (VG-S, BG-B, AS-M, JML-R, MI-G); Servicio de Bioquímica Clínica, Hospital Universitario de Salamanca (BG-B, JMG-B, MI-G); Servicio de Farmacia, Hospital Universitario de Salamanca, Spain (AS-M); Division of Clinical Pharmacology, Toxicology and Therapeutic Innovation, Children's Mercy Hospital (AG); Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA (AG); and Departamento de Medicina, Universidad de Salamanca, Spain (MI-G).
authors.forename: Santiago
authors.initials: S
authors.lastname: Sánchez-Iglesias
authors.forename: Virginia
authors.initials: V
authors.lastname: García-Solaesa
authors.forename: Belén
authors.initials: B
authors.lastname: García-Berrocal
authors.forename: Almudena
authors.initials: A
authors.lastname: Sanchez-Martín
authors.forename: Carolina
authors.initials: C
authors.lastname: Lorenzo-Romo
authors.forename: Tomás
authors.initials: T
authors.lastname: Martín-Pinto
authors.forename: Andrea
authors.initials: A
authors.lastname: Gaedigk
authors.forename: José Manuel
authors.initials: JM
authors.lastname: González-Buitrago
authors.forename: María
authors.initials: M
authors.lastname: Isidoro-García
mesh_terms: D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics; D019389:Cytochrome P-450 CYP2D6 / Q000235:genetics* / Q000378:metabolism; D005819:Genetic Markers; D005838:Genotype; D006801:Humans; D061214:Patient Safety; D058996:Quality Improvement; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D019389:Cytochrome P-450 CYP2D6; D005819:Genetic Markers; D017367:Selective Serotonin Reuptake Inhibitors