Psychiat Danub
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The concept of personalized drug therapy on the basis of genetic investigations has become a major issue in psychopharmacology. Pharmacogenetic studies have focused on polymorphisms in liver cytochrome P450 isoenzymes that metabolize many antidepressant and antipsychotic medications. The most significant results are the association between drug metabolic polymorphisms of cytochrome P450 with variations in drug metabolic rates and side effects. ⋯ Genetic tests for the pretreatment prediction of antipsychotic response have obvious implications for the selection of most appropriate drug and dose and contribute for the optimization of antipsychotic treatment. The pretreatment determination of individual's drug metabolic rates by CYP genotyping is the leading field. This review summarizes the present knowledge of associations between cytochrome P450 isoenzymes and the efficacy and side effects of antipsychotics.
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The stress -vulnerability model (Zubin et al. 1977) is an extremely useful model for identifying and treating relapses of mental illness. We accept that human persons carry genetic and other predisposition to mental illness. However, the question arises as to how stress impacts on a person in order to cause mental illness to develop. Furthermore there arises the issue as to what other effects such stress has on the human body beyond the human brain. Our aim was to research and integrate the current literature in order to establish how stress impacts on the brain at the cellular level, and to establish whether there are other consequences for the human body brought about by the impact of stress on the human brain. ⋯ We have identified communalities in how the interplay between stress and vulnerability occurs in different disease processes.
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Suicidality is one of the great challenges in contemporary psychiatry. Suicidal patients are often misdiagnosed in clinical practice. It is very important to evaluate possible comorbidity in diagnostic assessment of suicidal patients. ⋯ Because of heterogeneity of the BPD, pharmacologic treatment has evolved to some particular dimensions of BPD rather than the disorder in its entirety. The dimensions include affective instability, impulsive aggression and identity disturbance. Effective medication management reduces the overall suffering of the patient and enables to make greater use of psychotherapeutic interventions which is very important for BPD patients with BD comorbidity.
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When looking back in the history of psychiatry, the concept of reactivity had very variable impact on ethiological considerations. If classification of mental disorders is taken as a proxy, it seems that this impact is presently at the lowest that it has been in the last hundred years. ⋯ He pleads for a rethinking of the current position as stated in ICD-10. Reintroduction of a certain degree of the reactivity concept into the classification seems to be required.
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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 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.