Review and Consensus on Pharmacogenomic Testing in Psychiatry

Author:

Bousman Chad A.1234,Bengesser Susanne A.5,Aitchison Katherine J.6,Amare Azmeraw T.78,Aschauer Harald9,Baune Bernhard T.10411,Asl Bahareh Behroozi6,Bishop Jeffrey R.12,Burmeister Margit13,Chaumette Boris1415,Chen Li-Shiun16,Cordner Zachary A.17,Deckert Jürgen18,Degenhardt Franziska1920,DeLisi Lynn E.21,Folkersen Lasse22,Kennedy James L.2324,Klein Teri E.25,McClay Joseph L.26,McMahon Francis J.27,Musil Richard28,Saccone Nancy L.16,Sangkuhl Katrin25,Stowe Robert M.29,Tan Ene-Choo30,Tiwari Arun K.2324,Zai Clement C.2324,Zai Gwyneth2324,Zhang Jianping31,Gaedigk Andrea32,Müller Daniel J2324

Affiliation:

1. Departments of Medical Genetics, Psychiatry, Physiology & Pharmacology, University of Calgary, Calgary, AB, Canada

2. Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

3. Alberta Children’s Hospital Research Institute, Calgary, AB, Canada

4. Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia

5. Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria

6. Departments of Psychiatry, Medical Genetics and the Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada

7. Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, SA, Australia

8. South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia

9. Biopsychosocial Corporation (BioPsyC), non-profit association, Vienna, Austria

10. Department of Psychiatry and Psychotherapy, University of Münster, Germany

11. The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia

12. Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy and Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA

13. Michigan Neuroscience Institute and Departments of Computational Medicine & Bioinformatics, Human Genetics and Psychiatry, The University of Michigan, Ann Arbor MI, USA

14. Institute of Psychiatry and Neuroscience of Paris, GHU Paris Psychiatrie & Neurosciences, University of Paris, Paris, France

15. Department of Psychiatry, McGill University, Montreal, Canada

16. Departments of Psychiatry and Genetics, Washington University School of Medicine in St. Louis, USA

17. Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA

18. Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, Würzburg, Germany

19. Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany

20. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Duisburg, Germany

21. Department of Psychiatry, Harvard Medical School, Cambridge Health Alliance, Cambridge, Massachusetts, USA

22. Institute of Biological Psychiatry, Capital Region Hospitals, Copenhagen, Denmark

23. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

24. Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada

25. Department of Biomedical Data Science, Stanford University, Stanford, California, USA

26. Department of Pharmacotherapy and Outcome Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA

27. Human Genetics Branch, National Institute of Mental Health, Bethesda, MD, USA

28. Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany

29. Departments of Psychiatry and Neurology (Medicine), University of British Columbia, USA

30. KK Research Centre, KK Women’s and Children’s Hospital, Singapore, Singapore

31. Department of Psychiatry, Weill Cornell Medical College, New York-Presbyterian Westchester Division, White Plains, NY, USA

32. Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation, Children’s Mercy Kansas City, Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA

Abstract

AbstractThe implementation of pharmacogenomic (PGx) testing in psychiatry remains modest, in part due to divergent perceptions of the quality and completeness of the evidence base and diverse perspectives on the clinical utility of PGx testing among psychiatrists and other healthcare providers. Recognizing the current lack of consensus within the field, the International Society of Psychiatric Genetics assembled a group of experts to conduct a narrative synthesis of the PGx literature, prescribing guidelines, and product labels related to psychotropic medications as well as the key considerations and limitations related to the use of PGx testing in psychiatry. The group concluded that to inform medication selection and dosing of several commonly-used antidepressant and antipsychotic medications, current published evidence, prescribing guidelines, and product labels support the use of PGx testing for 2 cytochrome P450 genes (CYP2D6, CYP2C19). In addition, the evidence supports testing for human leukocyte antigen genes when using the mood stabilizers carbamazepine (HLA-A and HLA-B), oxcarbazepine (HLA-B), and phenytoin (CYP2C9, HLA-B). For valproate, screening for variants in certain genes (POLG, OTC, CSP1) is recommended when a mitochondrial disorder or a urea cycle disorder is suspected. Although barriers to implementing PGx testing remain to be fully resolved, the current trajectory of discovery and innovation in the field suggests these barriers will be overcome and testing will become an important tool in psychiatry.

Publisher

Georg Thieme Verlag KG

Subject

Pharmacology (medical),Psychiatry and Mental health,General Medicine

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