Psychiatric disorders are among the leading causes of disability worldwide. One fifth of the population will suffer from a psychiatric disorder in their lifetime. Antipsychotic and antidepressant drugs remain the cornerstone of treatment in schizophrenia and mood disorders. However, more than 50% of patients do not respond well to their initial treatment and much time is often spent until the right medication is found for the right patient. In addition, some develop serious side-effects that cause them to discontinue the medication. Thus, predictive tools would be of enormous help to optimize and personalize medication treatment.
Genomics offer a tremendous opportunity to personalize medication treatment by use of preemptive genotyping selected genes known to be involved in drug metabolism, neurotransmission and occurrence of side effects. Over the past decade, evidence has emerged that assessing gene variants for drug metabolizing enzymes such CYP2D6 or CYP2C19 can be used to improve treatment with antidepressant and antipsychotics. In addition, various gene variants have been identified involved in psychotropic medication induced side effects such ads for carbamazepine-induced Steven-Johnsons Syndrome or antipsychotic-induced weight gain.
The presentation will review current recommendations provided by expert panels such as the Clinical Pharmacogenomics Implementation Consortium (CPIC) and regulatory agencies (e.g., FDA). Data from our own research studies in Toronto including more than 7,000 patients will be presented showing acceptance and benefits of genetic testing in clinical practice. In addition, implementation strategies and cost-benefits will be reviewed, and commercially available test kits will be critically discussed.
Learning Objective 1: Understanding principles of how genetics influences response and side effects in psychopharmacology
Learning Objective 2: Application of pharmacogenetics in clinical practice