Filaković Pavo, Petek Anamarija
University Department of Psychiatry, Clinical Hospital Osijek, Osijek, Croatia.
Psychiatr Danub. 2009 Sep;21(3):341-6.
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.
每个人都独特且不同，这导致疾病具有异质性，这一假设为个性化医疗的概念奠定了基础。个性化精神病学遵循个性化医疗的原则。针对精神病患者的个体化适应方法的一个组成部分通过个性化精神病学得以充分体现。药物基因组学和药物遗传学的发展以及基于它们的纳米技术，比其他医学学科更能确保在精神病学中实施个性化医疗原则。在药物基因组学领域，通过对药物代谢中的基因变异性研究取得了最大进展。现在，在常规实践中进行药物遗传学检测的所有先决条件都已具备。对通过两种多态性细胞色素P 450（CYP2D6和CYP2C19）进行代谢的药物进行药物遗传学检测具有特殊意义，因为它们参与了大多数精神药物的不良和超快代谢。在药物遗传学和药物基因组学的支持下，个性化医疗在精神病学中的潜在应用包括：个性化药物选择、个性化剂量、个体预测可能的副作用以及个性化康复后续治疗。作者总结了药物基因组学和药物遗传学以及基于它们的纳米技术的发展，如何在创建精神病学个性化治疗方法方面向前迈进了一步。然而，应用最合适的治疗药物和逐渐减少用药剂量的负担仍然基于临床医生的决定。药物遗传学只能通过减少一个未知因素来辅助做出治疗决策。
