Pharmacogenetics and Psychiatric Care: A Review and Commentary

Butler, Merlin G.

doi:10.29245/2578-2959/2018/2.1120

Cited by 25 publications

(31 citation statements)

References 59 publications

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“…Personalized or precision medicine is emerging in clinical practice based on individual genetic patterns contributing to pharmacogenetics, particularly in the field of psychiatry and treating individuals with ASD [102][103][104][105] with behavior issues including ADHD, irritability, aggression and self-injury, repetitive behaviors, and persistent insomnia addressed above. Pharmacogenetics is a study of structural DNA variation that impacts drug metabolism [106,107] and most often based on the cytochrome P450 enzyme system, primarily active in the liver and coded by genes.…”

Section: Pharmacogenetics and Role In Medication Selection And Managementioning

confidence: 99%

“…There are over 50 cytochrome P450 hepatic enzymes that are primarily found in the mitochondria [102][103][104][105]. These enzymes metabolize endogenous and xenobiotic substrates including environmental pollutants and agricultural and plant-based chemicals and are involved in biosynthesis and metabolism of steroids, vitamins, hormones, lipids, and prostaglandins.…”

Section: Pharmacogenetics and Role In Medication Selection And Managementioning

confidence: 99%

“…About 90% of all drugs are metabolized by seven different cytochrome enzymes including CYP1A2, CYP3A4, CYP3A5, CYPC19, CYP2D6, CYP2C9 and CYP2B6 [106,[109][110][111]. The most commonly prescribed medications used in treating patients with psychiatric problems and ASD are broken down by CYP2D6 [102][103][104][105]. It should also be noted that many drugs are also metabolized by more than one cytochrome P450 enzyme and in addition some drugs (e.g., risperidone) require break down to generate an active metabolite or functional agent for treatment.…”

Section: Pharmacogenetics and Role In Medication Selection And Managementioning

confidence: 99%

“…Similarly, a better understanding of the metabolic differences that occur with age will further impact on drug dosage and selection of specific therapeutic agents. Therefore, personalized medicine requires the development of resources for clinicians including pharmacogenetic dosing guidelines for medications, as 25 to 50% of individuals do not respond normally to drug dosage or treatment, and this scenario also applies to those with ASD [102].…”

Section: Pharmacogenetics and Role In Medication Selection And Managementioning

confidence: 99%

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Clinical Assessment, Genetics, and Treatment Approaches in Autism Spectrum Disorder (ASD)

Genovese

Butler

2020

IJMS

159

107

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Autism spectrum disorder (ASD) consists of a genetically heterogenous group of neurobehavioral disorders characterized by impairment in three behavioral domains including communication, social interaction, and stereotypic repetitive behaviors. ASD affects more than 1% of children in Western societies, with diagnoses on the rise due to improved recognition, screening, clinical assessment, and diagnostic testing. We reviewed the role of genetic and metabolic factors which contribute to the causation of ASD with the use of new genetic technology. Up to 40 percent of individuals with ASD are now diagnosed with genetic syndromes or have chromosomal abnormalities including small DNA deletions or duplications, single gene conditions, or gene variants and metabolic disturbances with mitochondrial dysfunction. Although the heritability estimate for ASD is between 70 and 90%, there is a lower molecular diagnostic yield than anticipated. A likely explanation may relate to multifactorial causation with etiological heterogeneity and hundreds of genes involved with a complex interplay between inheritance and environmental factors influenced by epigenetics and capabilities to identify causative genes and their variants for ASD. Behavioral and psychiatric correlates, diagnosis and genetic evaluation with testing are discussed along with psychiatric treatment approaches and pharmacogenetics for selection of medication to treat challenging behaviors or comorbidities commonly seen in ASD. We emphasize prioritizing treatment based on targeted symptoms for individuals with ASD, as treatment will vary from patient to patient based on diagnosis, comorbidities, causation, and symptom severity.

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Section: Pharmacogenetics and Role In Medication Selection And Managementioning

confidence: 99%

Section: Pharmacogenetics and Role In Medication Selection And Managementioning

confidence: 99%

Section: Pharmacogenetics and Role In Medication Selection And Managementioning

confidence: 99%

Section: Pharmacogenetics and Role In Medication Selection And Managementioning

confidence: 99%

See 2 more Smart Citations

Clinical Assessment, Genetics, and Treatment Approaches in Autism Spectrum Disorder (ASD)

Genovese

Butler

2020

IJMS

159

107

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“…28 The CYP2D6 gene affects the metabolism of approximately 25% of commonly prescribed medications, which includes opioids, antipsychotics, and tricyclic antidepressants. 29 Also, the CYP2C19 gene plays a central role in the metabolism of common antidepressants such as citalopram, escitalopram, imipramine, and amitriptyline. 30 For example, a 2019 study demonstrated significantly higher rates of CYP2C19 poor metabolizer variants in patients with bipolar disorder than in those with major depressive disorder among patients with a history of multiple drug failures and treatment resistance.…”

Section: Evidence-based Testingmentioning

confidence: 99%

Untitled

2019

IJFCM

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Pharmacogenetics is a rapidly advancing field of genetic medicine that offers promise for improved patient outcomes. Prescription drugs dominate the medical system, which makes it imperative to utilize technology which identifies gene-drug compatibility. Clinicians in a private clinical setting must understand the definitions and science behind pharmacogenetics (PGx). There are at least five good reasons for clinicians to implement PGx into their practice. There is emerging research demonstrating that PGx can decrease hospital admissions as well as adverse drug events in large specialties such as cardiology, oncology, and psychiatry. In some situations PGx has been demonstrated to be cost-effective. Drugs that have compelling gene-drug research included in this review include warfarin, clopidogrel, cholesterol-lowering statins, abacavir, antidepressants, and irinotecan. There are also limitations to evidence-based gene-drug interactions that clinicians should be familiar with. Lastly, there are several considerations that clinicians should be aware of in regards to legal and ethical concerns.

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Clinical and Genetic Findings with Natural History of Prader-Willi Syndrome

Butler

Thompson²

2022

Management of Prader-Willi Syndrome

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Pharmacogenetics and Psychiatric Care: A Review and Commentary

Cited by 25 publications

References 59 publications

Clinical Assessment, Genetics, and Treatment Approaches in Autism Spectrum Disorder (ASD)

Clinical Assessment, Genetics, and Treatment Approaches in Autism Spectrum Disorder (ASD)

Untitled

Clinical and Genetic Findings with Natural History of Prader-Willi Syndrome

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