Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Affective Disorders, Aarhus University Hospital Psychiatry, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark.
Psychiatry Res. 2020 Oct;292:113336. doi: 10.1016/j.psychres.2020.113336. Epub 2020 Jul 27.
In this narrative, we evaluate the role of pharmacogenetics in psychiatry from a pragmatic clinical perspective and address current barriers of clinical implementation of pharmacogenetics. Pharmacogenetics has been successfully implemented to improve drug therapy in several clinical areas, but not psychiatry. Yet, psychotropics account for more than one-third of the drugs for which pharmacogenetic guidelines are available and drug therapy in mental disorders is suboptimal with insufficient effectiveness and frequent adverse events. The limited application of pharmacogenetics in psychiatry is influenced by several factors; e.g. the complexity of psychotropic drug metabolism, possibly impeding the clinical understanding of the benefits of pharmacogenetics. Also, recommendations for most psychotropics classify pharmacogenetic testing only as (potentially) beneficial, not as essential, possibly because life-threatening adverse events are often not involved in these drug-gene interactions. Implementing pharmacogenetics in psychiatry could improve the current practice of time-consuming switching of therapies causing undue delays associated with worse outcomes. We expect pharmacogenetics in psychiatry to expedite with panel-based genotyping, including clinically relevant variants, which will address the complex enzymatic metabolism of psychotropic drugs. Until then, we stress that available pharmacogenetic testing should be seen as an integrated companion, not a competitor, in current clinical psychiatric care.
在这篇叙述中，我们从实用的临床角度评估了精神医学中的药物遗传学作用，并讨论了目前药物遗传学临床实施的障碍。药物遗传学已成功应用于改善多个临床领域的药物治疗，但在精神医学中并未如此。然而，精神药物占具有药物遗传学指导方针的药物的三分之一以上，精神障碍的药物治疗效果不佳，疗效不足且不良反应频繁。药物遗传学在精神医学中的应用有限受到多种因素的影响；例如，精神药物代谢的复杂性可能会阻碍对药物遗传学益处的临床理解。此外，大多数精神药物的建议仅将药物遗传学检测分类为（潜在）有益，而不是必需，这可能是因为这些药物-基因相互作用通常不涉及危及生命的不良反应。在精神医学中实施药物遗传学可以改善当前治疗方法的局限性，这些方法会导致不必要的延误，从而导致治疗效果更差。我们期望精神医学中的药物遗传学能够通过基于面板的基因分型来加快进展，包括具有临床相关性的变异，这将解决精神药物复杂的酶代谢问题。在此之前，我们强调应该将现有的药物遗传学检测视为当前临床精神护理的一个集成辅助手段，而不是竞争对手。
