Pharmacogenetics Informed Decision Making in Adolescent Psychiatric Treatment: A Clinical Case Report

Abstract

Advances made in genetic testing and tools applied to pharmacogenetics are increasingly being used to inform clinicians in fields such as oncology, hematology, diabetes (endocrinology), cardiology and expanding into psychiatry by examining the influences of genetics on drug efficacy and metabolism. We present a clinical case example of an adolescent male with anxiety, attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder who did not tolerate numerous medications and dosages over several years in attempts to manage his symptoms. Pharmacogenetics testing was performed and DNA results on this individual elucidated the potential pitfalls in medication use because of specific pharmacodynamic and pharmacokinetic differences specifically involving polymorphisms of genes in the cytochrome p450 enzyme system. Future studies and reports are needed to further illustrate and determine the type of individualized medicine approach required to treat individuals based on their specific gene patterns. Growing evidence supports this biological approach for standard of care in psychiatry.

Pharmacogenomic testing: aiding in the management of psychotropic therapy for adolescents with autism spectrum disorders

“… 9 , 10 There have been case reports where pharmacogenomics testing results were successfully utilized resulting in improved symptom management and overall quality of life among children and adolescents with complex behavior health issues. 11 , 12 There is, therefore, precedence in pediatric care for pharmacogenomic testing in high-risk populations. While pharmacogenomic testing must be carefully researched and monitored prior to broad generalization to general adolescent populations, implementing pharmacogenomic testing in adolescents with autism on one or more psychotropic medications may be warranted because of their high-risk profile.…”

“…While pharmacogenomic testing is an emerging resource, it can be an effective tool for primary care pediatricians to assist in the management of adolescent patients with autism who are on psychotropic medication. 11 In our proposed practice, noninvasive gene testings can be offered to patients with autism who are on one or more of these medications. Patients who can potentially benefit from such testings are identified by our clinical staff using electronic health record based population management.…”

Clinical utility of pharmacogenetic testing in children and adolescents with severe mental disorders

“…In another review of PGx testing in child and adolescent psychiatry, the authors concluded that PGx testing might help in predicting treatment response and adverse events, as well as medication selection in children and adolescents with depressive disorders, anxiety disorders, and ADHD (Wehry et al 2018 ). Furthermore, in a case report using the Genecept assay testing (Genomind, Chalfont, PA, USA), the authors reported that PGx testing helped in prescribing the most effective medication, thus illustrating “how pharmacogenetics and psychiatry can potentially interface to provide more informed decision-making regarding use of psychotropic medications” (Smith et al 2015 ).…”

“…Strengths of the present study include: (1) the naturalistic, real-world clinical practice design and (2) a population of particular interest: children and adolescents with severe mental disorders. To our knowledge, there are no previous reports of clinical use of any particular PGx test in children and adolescents except for a two-case report study using Neuropharmagen (De Crescenzo et al 2016 ) and a single case report using Genecept assay testing (Smith et al 2015 ). Limitations include: (1) a small sample size; (2) the particularly severe profile, particularly of foster care children, which are not representative of the “regular” children followed-up at mental health centers; (3) the lack of clinical scales apart from CGS-S and CGS-I; (4) the lack of a proper control group; (5) the use of one of the potential definitions of polypharmacy (Chen et al 2011 ; Fontanella et al 2014 ) and clinical utility (Bousman and Hopwood 2016 ; de Leon 2016 ); and, finally, (6) our lack of opportunity to conduct a cost-effectiveness analysis.…”

“…Preliminary reports of different pharmacogenetic decision support tools are promising (Espadaler et al 2016 ; Smith et al 2015 ; Chau and Thomas 2015 ). Our study is in keeping with these studies but in a youth population, and suggests that PGx testing might help clinicians in the process of decision-making about the best drug choice for a particular child diagnosed with a mental disorder.…”