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Related Concept Videos

Drug Therapy01:28

Drug Therapy

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The advent of drug therapy has profoundly shaped modern mental health care, providing targeted treatments for a range of psychological disorders. Psychotherapeutic drugs, classified into antianxiety, antidepressant, and antipsychotic medications, address symptoms across anxiety disorders, mood disorders, and schizophrenia. While these medications have transformed patient outcomes, they require careful management due to their potential side effects and limitations.
Antianxiety Medications
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Psychosis: Goals of Pharmacotherapy01:26

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Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
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Dosage Regimen: Individualization01:24

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Individualization in dosing regimens is the customization of medication doses for individual patients. Its necessity arises from the goal of maximizing therapeutic benefits while minimizing risks. This approach is pivotal because human responses to drugs can vary widely; what is effective for one person may be inadequate or excessive for another. Interpatient (intersubject) variability refers to differences in drug responses between individuals, while intrapatient (intrasubject) variability...
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It is not uncommon for complete drug pharmacokinetic profiles to remain elusive in pharmacokinetics. This necessitates certain educated assumptions by pharmacokineticists to determine appropriate dosage regimens without comprehensive pharmacokinetic data from animal or human studies. One prevalent assumption is setting the bioavailability factor, denoted as F, to 1 or 100%. This assumption caters to the scenario where a drug doesn't achieve full systemic absorption, resulting in the patient...
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Analysis of population pharmacokinetic data involves studying the behavior of drugs within diverse populations to understand their pharmacokinetic parameters. Traditional pharmacokinetic methods typically involve collecting samples from a few individuals and estimating these parameters. While these methods are commonly used, they have limitations in capturing the variability in drug response among individuals or heterogeneous populations. Population pharmacokinetics is employed to address these...
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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Medication Optimization Using Pharmacogenomic Testing in a Complex Mental Health Population Prescribed Psychiatric

Amanda Ernst Wood1,2, Deepika Agrawal1, Alison P Deem1,2

  • 1VA Puget Sound Health Care System, American Lake Division (A-116-R), Tacoma, Washington, USA.

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Summary

Pharmacogenomic (PGx) testing guided medication changes in Veterans with polypharmacy, improving depression and mental health quality of life. PGx assays offer personalized treatment for complex medication regimens.

Keywords:
clinical pharmacology (CPH)clinical research (CRE)drug-drug interactionspharmacogenetics/pharmacogenomicspsychiatry (PSY)

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Area of Science:

  • Pharmacogenomics
  • Clinical Pharmacology
  • Psychiatric Pharmacy

Background:

  • Polypharmacy is increasingly common, raising risks of drug interactions and adverse drug reactions.
  • Pharmacogenomic (PGx) assays predict individual medication responses based on genetic markers.
  • Optimizing medication regimens for polypharmacy patients is a significant clinical challenge.

Purpose of the Study:

  • To examine the impact of PGx results on clinical management of Veterans prescribed psychiatric polypharmacy.
  • To assess the utility of PGx assays in guiding medication adjustments for complex patient populations.
  • To evaluate the effect of PGx-guided interventions on clinical outcomes and adverse drug effects.

Main Methods:

  • A 12-week pilot study involving 53 Veteran outpatients on polypharmacy (mean 13.15 medications).
  • Psychiatric medication providers accessed PGx assay results and an algorithm decision tool for drug-drug-gene interactions.
  • Medication management decisions were informed by PGx data, with providers changing original plans in 83% of cases.

Main Results:

  • Clinical improvement observed in depression (P=.01) and mental health quality of life (P<.05) over 12 weeks.
  • Adverse drug effects remained unchanged or improved.
  • Polypharmacy rates were unchanged, but medication regimens were adjusted based on PGx findings.

Conclusions:

  • Medication changes guided by PGx assays may benefit Veterans with psychiatric polypharmacy.
  • PGx testing can facilitate personalized medication management in complex patient populations.
  • The study suggests PGx assays are a valuable tool for optimizing polypharmacy treatment.