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Pharmacogenomics in Psychiatry: Is There a Role?
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This document is a transcript of a presentation on the topic of pharmacogenomics in psychiatry, which was part of the Clinical Support System for Serious Mental Illness (CSS-SMI) initiative conducted by the American Psychiatric Association (APA) and the Substance Abuse and Mental Health Services Administration (SAMHSA). The presenter, Megan Ehret, PharmD, MS, BCPP, discussed the role and current utilization of pharmacogenomics in the treatment of serious mental illness.<br /><br />Pharmacogenomics refers to the study of how an individual's genetic makeup influences their response to medications. It involves analyzing genes that are involved in drug metabolism, transport, and target interactions. These genetic variations can affect the pharmacokinetics (how the body processes the drug) and pharmacodynamics (how the drug interacts with the body) of psychiatric medications.<br /><br />The presentation discussed various pharmacogenomic mechanisms, including pharmacokinetic enzymes such as CYP2C9, CYP2C19, CYP2D6, and UDP-glucuronosyltransferase, as well as pharmacodynamic factors such as neurotransmitter receptors and gene transcription.<br /><br />The presenter also outlined available guidelines and product labels for different classes of psychiatric medications, such as antipsychotics, antidepressants, mood stabilizers/anticonvulsants, anxiolytics/hypnotics, and ADHD medications. These guidelines provide recommendations on how to adjust medication dosages or consider alternative drugs based on an individual's genetic profile.<br /><br />The presentation highlighted considerations and challenges in implementing pharmacogenomic testing in clinical practice. These include selecting appropriate test providers, ensuring test content and analytical validity, assessing test feasibility and clinical efficacy, interpreting and delivering test results, integrating pharmacogenomic information into electronic medical records, and capturing the impact and cost-effectiveness of pharmacogenomic testing in routine clinical practice.<br /><br />In conclusion, pharmacogenomics has the potential to be a valuable decision-support tool in psychiatric treatment. However, further research and expert guidance are needed to optimize its use and ensure that it is effectively integrated into clinical practice.
Keywords
pharmacogenomics
psychiatry
Clinical Support System for Serious Mental Illness
genetic makeup
pharmacokinetics
pharmacodynamics
antipsychotics
antidepressants
genetic profile
pharmacogenomic testing
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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