Optimisation of pharmacotherapy in psychiatry through therapeutic drug monitoring, molecular brain imaging and pharmacogenetic tests: Focus on antipsychotics

Xenia Marlene Hart, Gerhard Gründer, Nicolas Ansermot, Andreas Conca, Emmanuelle Corruble, Severine Crettol, Paul Cumming, Ariel Frajerman, Gudrun Hefner, Oliver Howes, Marin M Jukic, Euitae Kim, Seoyoung Kim, Ignazio Maniscalco, Sho Moriguchi, Daniel J. Müller, Shinichiro Nakajima, Martin Osugo, Michael Paulzen, Henricus Gerardus RuheMaike Scherf-Clavel, Georgios Schoretsanitis, Alessandro Serretti, Edoardo Spina, Olav Spigset, Werner Steimer, Sinan H. Süzen, Hiroyuki Uchida, Stefan Unterecker, Frederik Vandenberghe, Celine Verstuyft, Gerald Zernig, Christoph Hiemke, Chin B. Eap

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Background: For psychotic disorders (i.e. schizophrenia), pharmacotherapy plays a key role in controlling acute and long-term symptoms. To find the optimal individual dose and dosage strategy, specialised tools are used. Three tools have been proven useful to personalise drug treatments: therapeutic drug monitoring (TDM) of drug levels, pharmacogenetic testing (PG), and molecular neuroimaging. Methods: In these Guidelines, we provide an in-depth review of pharmacokinetics, pharmacodynamics, and pharmacogenetics for 45 antipsychotics. Over 30 international experts in psychiatry selected studies that have measured drug concentrations in the blood (TDM), gene polymorphisms of enzymes involved in drug metabolism, or receptor/transporter occupancies in the brain (positron emission tomography (PET)). Results: Study results strongly support the use of TDM and the cytochrome P450 (CYP) genotyping and/or phenotyping to guide drug therapies. Evidence-based target ranges are available for titrating drug doses that are often supported by PET findings. Conclusion: All three tools discussed in these Guidelines are essential for drug treatment. TDM goes well beyond typical indications such as unclear compliance and polypharmacy. Despite its enormous potential to optimise treatment effects, minimise side effects and ultimately reduce the global burden of diseases, personalised drug treatment has not yet become the standard of care in psychiatry.

Original languageEnglish
Pages (from-to)451-536
Number of pages86
JournalWorld Journal of Biological Psychiatry
Volume25
Issue number9
DOIs
StatePublished - 2024

Keywords

  • therapeutic drug monitoring, pharmacogenetic testing, molecular neuroimaging, antipsychotics

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