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Case report: Avoiding intolerance to antipsychotics through a personalized treatment approach based on
Liam Korošec Hudnik1, Tanja Blagus2, Sara Redenšek Trampuž2
1Centre for Clinical Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia.
Frontiers in Psychiatry
|April 3, 2024
Summary
Pharmacogenetic testing helps tailor antipsychotic treatment by identifying genetic variations that influence drug response and side effects. This personalized approach improves treatment effectiveness and reduces adverse drug reactions (ADRs) in psychiatric care.
Area of Science:
- Pharmacogenetics
- Psychiatry
- Clinical Pharmacology
Background:
- Standard psychiatric treatment, "treatment as usual" (TAU), often involves trial-and-error medication adjustments due to ineffectiveness and adverse drug reactions (ADRs).
- Genetic variability in drug-metabolizing enzymes (e.g., CYP450 system) contributes to inter-individual differences in antipsychotic efficacy and safety.
- Pharmacogenetic analysis of genes involved in antipsychotic metabolism can enhance understanding of treatment outcomes.
Observation:
- A 60-year-old patient experienced severe extrapyramidal symptoms and neuroleptic malignant syndrome with multiple antipsychotics.
- Pharmacogenetic analysis was performed, genotyping key genes (CYP2D6, CYP3A4, CYP1A2, ABCB1, ABCG2) involved in antipsychotic pharmacokinetics.
- Treatment recommendations were based on established pharmacogenetic guidelines (DPWG, CPIC).
Findings:
- Pharmacogenetic testing identified a specific metabolic profile explaining the patient's adverse drug reactions (ADRs).
- Personalized medication selection based on genetic results led to improved treatment efficacy and safety.
- Psychotic symptoms resolved, with a partial improvement in negative symptoms.
Implications:
- Pharmacogenetic testing can guide the selection of appropriate antipsychotics and optimal dosing, minimizing ADRs and treatment failures.
- This case highlights the utility of pharmacogenetics in personalizing psychiatric pharmacotherapy.
- Further research is needed to explore complex gene-drug and gene-gene-drug interactions in psychopathology.
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