Towards Personalized Psychiatry: Foreign Experience in Psychopharmacogenetics
https://doi.org/10.17803/lexgen-2025-4-2-76-93
Abstract
The work presents research into foreign experience of the shif t to personalized psychiatry when taking a psychopharmacogenetic approach. Contemporary trends in the development of genetically oriented treatment of psychiatric disorders are identified in recent international studies. A systematic review of the relevant literature reveals a growing interest in the individualized prescription of drugs based on a patient’s genetic profile as a means of increasing therapeutic ef fectiveness and reducing the risk of side ef fects. In order to evaluate the introduction of psychopharmacogenetics in foreign countries, the review includes data on diagnostic methods, drug prescription protocols, and clinical outcomes. The individual selection of dosages of antidepressants and antipsychotics is shown to have led to a significant increase in the ef fectiveness of treatments for a number of psychiatric diseases. Psychopharmacogenetics thus represents a promising area of modern psychiatry, having the potential to significantly improve the quality of life of patients. However, further clinical trials are needed before introducing appropriate technologies into healthcare practice. Limitations of the study include the small sizes of the study populations and the lack of representativeness of the samples. For this reason, caution should be taken when extrapolating the findings to the general population.
About the Authors
N. V. Zakharova
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology ; Samara State Medical University (SamSMU)
Russian Federation
Russian Federation
Natalya V. Zakharova, Candidate of Science (Medicine), Leading Researcher at the Institute of Personalized Psychiatry and Neurology; Leading Expert at the Scientific and Educational Center of Neuropsychiatry
Saint Petersburg; Samara
R. F. Nasyrova
V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology
Russian Federation
Russian Federation
Regina F. Nasyrova, Doctor of Science (Medicine), Head of the Institute of Personalized Psychiatry and Neurology
Saint Petersburg
References
1. Alonso, S.G., de la Torre Díez, I., Zapiraín, B.G. (2019). Predictive, personalized, preventive and participatory (4P) medicine applied to telemedicine and eHealth in the literature. Journal of Medical Systems, 43, 140. https://doi.org/10.1007/s10916-019-1279-4
2. Arwood, M.J., Chumnumwat, S., Cavallari, L.H., Nutescu, E.A., Duarte, J.D. (2016). Implementing pharmacogenomics at your institution: establishment and overcoming implementation challenges. Clinical and translational science, 9(5), 233–245. https://doi.org/10.1111/cts.12404
3. Avilov, A.Y., Kidyaeva, A.V., Vaiman, E.E. (2024). Predictive Pharmacogenetic Testing in Psychiatry: Pros and Cons. Personalized Psychiatry and Neurology, 4(1), 40–49. https://doi.org/10.52667/10.52667/2712-9179-2024-4-1-40-49
4. Barin-Le Guellec, C., Picard, N., Alarcan, H., Barreau, M., Becquemont, L., Quaranta, S., ... Loriot, M. A. (2020). La pharmacogénétique au service du soin en France: une discipline qui évolue!. Therapies, 75(5), 459–470. https://doi.org/10.1016/j.therap.2019.09.006
5. Bousman, C.A., Bengesser, S.A., Aitchison, K.J., Amare, A.T., Aschauer, H., Baune, B.T., ... Müller, D.J. (2021). Review and consensus on pharmacogenomic testing in psychiatry. Pharmacopsychiatry, 54(01), 5–17. https://doi.org/10.1055/a-1288-1061
6. Bousman, C., Al Maruf, A., Müller, D.J. (2019). Towards the integration of pharmacogenetics in psychiatry: a minimum, evidence-based genetic testing panel. Current opinion in psychiatry, 32(1), 7–15. https://doi.org/10.1097/YCO.0000000000000465
7. Brown, L.C., Lorenz, R.A., Li, J., Dechairo, B.M. (2017). Economic utility: combinatorial pharmacogenomics and medication cost savings for mental health care in a primary care setting. Clinical Therapeutics, 39(3), 592–602. https://doi.org/10.1016/j.clinthera.2017.01.022
8. Caudle, K.E., Dunnenberger, H.M., Freimuth, R.R., Peterson, J.F., Burlison, J.D., Whirl-Carrillo, M., ... Hoffman, J.M. (2017). Standardizing terms for clinical pharmacogenetic test results: consensus terms from the Clinical Pharmacogenetics Implementation Consortium (CPIC). Genetics in Medicine, 19(2), 215–223. https://doi.org/10.1038/gim.2016.87
9. Crews, K.R., Gaedigk, A., Dunnenberger, H.M., Klein, T.E., Shen, D.D., Callaghan, J.T., ... Skaar, T.C. (2012). Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines for codeine therapy in the context of cytochrome P450 2D6 (CYP2D6) genotype. Clinical Pharmacology & Therapeutics, 91(2), 321–326. https://doi.org/10.1038/clpt.2011.287
10. Demkow, U., Wolańczyk, T. (2017). Genetic tests in major psychiatric disorders—integrating molecular medicine with clinical psychiatry–why is it so difficult?. Translational psychiatry, 7, e1151. https://doi.org/10.1038/tp.2017.106
11. Ehmann, F., Caneva, L., Papaluca, M. (2014). European Medicines Agency initiatives and perspectives on pharmacogenomics. British journal of clinical pharmacology, 77(4), 612–617. https://doi.org/10.1111/bcp.12319
12. Flowers, C.R., Veenstra, D. (2004). The role of cost-effectiveness analysis in the era of pharmacogenomics. Pharmacoeconomics, 22, 481–493. https://doi.org/10.2165/00019053-200422080-00001
13. Howland, R.H. (2014). Pharmacogenetic testing in psychiatry: not (quite) ready for primetime. Journal of psychosocial nursing and mental health services, 52(11), 13–16. https://doi.org/10.3928/02793695-20141021-09
14. Johnson, J.A., Gong, L., Whirl‐Carrillo, M., Gage, B.F., Scott, S.A., Stein, C.M., ... Altman, R.B. (2011). Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C9 and VKORC1 genotypes and warfarin dosing. Clinical Pharmacology & Therapeutics, 90(4), 625–629. https://doi.org/10.1038/clpt.2011.185
15. Joly, Y., Feze, I.N., Song, L., Knoppers, B.M. (2017). Comparative approaches to genetic discrimination: chasing shadows?. Trends in Genetics, 33(5), 299–302. https://doi.org/10.1016/j.tig.2017.02.002
16. Karamperis, K., Koromina, M., Papantoniou, P., Skokou, M., Kanellakis, F., Mitropoulos, K., ... Mitropoulou, C. (2021). Economic evaluation in psychiatric pharmacogenomics: a systematic review. The pharmacogenomics journal, 21, 533–541. https://doi.org/10.1038/s41397-021-00249-1
17. Khera, A. V., Chaffin, M., Aragam, K.G., Haas, M.E., Roselli, C., Choi, S.H., ... Kathiresan, S. (2018). Genomewide polygenic scores for common diseases identify individuals with risk equivalent to monogenic mutations. Nature genetics, 50, 1219–1224. https://doi.org/10.1038/s41588-018-0183-z
18. Kumar, A., Kearney, A. (2021). The use of pharmacogenetic testing in psychiatry. Journal of the American Association of Nurse Practitioners, 33(11), 849–851. https://doi.org/10.1097/JXX.0000000000000666
19. Lázaro‐Muñoz, G., Sabatello, M., Huckins, L., Peay, H., Degenhardt, F., Meiser, B., ... ISPG Ethics Committee. (2019). International society of psychiatric genetics ethics committee: issues facing us. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 180(8), 543–554. https://doi.org/10.1002/ajmg.b.32736
20. Luzum, J.A., Pakyz, R.E., Elsey, A.R., Haidar, C.E., Peterson, J.F., Whirl‐Carrillo, M., ... Pharmacogenomics Research Network Translational Pharmacogenetics Program. (2017). The pharmacogenomics research network translational pharmacogenetics program: outcomes and metrics of pharmacogenetic implementations across diverse healthcare systems. Clinical Pharmacology & Therapeutics, 102(3), 502–510. https://doi.org/10.1002/cpt.630
21. Lydiard, J., Nemeroff, C.B. (2019). Biomarker-guided tailored therapy. In: Kim, Y.K. (ed.). Frontiers in Psychiatry. Advances in Experimental Medicine and Biology (Vol 1192, pp. 199–224). Singapore: Springer Singapore. https://doi.org/10.1007/978-981-32-9721-0_10
22. Martin, M.A., Klein, T.E., Dong, B.J., Pirmohamed, M., Haas, D.W., Kroetz, D.L. (2012). Clinical pharmacogenetics implementation consortium guidelines for HLA‐B genotype and abacavir dosing. Clinical Pharmacology & Therapeutics, 91(4), 734–738. https://doi.org/10.1038/clpt.2011.355
23. Molden, E., Jukić, M.M. (2021). CYP2D6 reduced function variants and genotype/phenotype translations of CYP2D6 intermediate metabolizers: implications for personalized drug dosing in psychiatry. Frontiers in Pharmacology, 12, 650750. https://doi.org/10.3389/fphar.2021.650750
24. Neiders, I., Mežinska, S., van Haren, N.E. (2025). Ethical and social issues in prediction of risk of severe mental illness: a scoping review and thematic analysis. BMC psychiatry, 25, 501. https://doi.org/10.1186/s12888-025-06949-3
25. Neznanov, N.G., Nasyrova, R.F., Shnayder, N.A. (2022). From classical to personalized psychoneurology. Personalized Psychiatry and Neurology, 2(1), 1–3. https://doi.org/10.52667/2712-9179-2022-2-1-1-3
26. Relling, M.V., Gardner, E.E., Sandborn, W.J., Schmiegelow, K., Pui, C.H., Yee, S.W., ... Klein, T.E. (2011). Clinical Pharmacogenetics Implementation Consortium guidelines for thiopurine methyltransferase genotype and thiopurine dosing. Clinical Pharmacology & Therapeutics, 89(3), 387–391. https://doi.org/10.1038/clpt.2010.320
27. Ross, C.J., Visscher, H., Sistonen, J., Brunham, L.R., Pussegoda, K., Loo, T.T., ... Hayden, M.R. (2010). The Canadian Pharmacogenomics Network for Drug Safety: a model for safety pharmacology. Thyroid, 20(7), 681–687. https://doi.org/10.1089/thy.2010.1642
28. Salloum, R.G., Bishop, J.R., Elchynski, A.L., Smith, D.M., Rowe, E., Blake, K.V., ... Tuteja, S. (2022). Best–worst scaling methodology to evaluate constructs of the Consolidated Framework for Implementation Research: application to the implementation of pharmacogenetic testing for antidepressant therapy. Implementation science communications, 3(1), 52. https://doi.org/10.1186/s43058-022-00300-7
29. Scott, S.A., Sangkuhl, K., Gardner, E.E., Stein, C.M., Hulot, J.S., Johnson, J.A., ... Shuldiner, A.R. (2011). Clinical Pharmacogenetics Implementation Consortium guidelines for cytochrome P450–2C19 (CYP2C19) genotype and clopidogrel therapy. Clinical Pharmacology & Therapeutics, 90(2), 328–332. https://doi.org/10.1038/clpt.2011.132
30. Thompson, C., Hamilton, S.P., Hippman, C. (2015). Psychiatrist attitudes towards pharmacogenetic testing, direct-to-consumer genetic testing, and integrating genetic counseling into psychiatric patient care. Psychiatry Research, 226(1), 68–72. https://doi.org/10.1016/j.psychres.2014.11.044
31. Varnai, R., Szabo, I., Tarlos, G., Szentpeteri, L.J., Sik, A., Balogh, S., Sipeky, C. (2020). Pharmacogenomic biomarker information differences between drug labels in the United States and Hungary: implementation from medical practitioner view. The Pharmacogenomics Journal, 20, 380–387. https://doi.org/10.1038/s41397-019-0123-z
32. Ward, E.T., Kostick, K.M., Lázaro-Muñoz, G. (2019). Integrating genomics into psychiatric practice: ethical and legal challenges for clinicians. Harvard review of psychiatry, 27(1), 53–64. https://doi.org/10.1097/HRP.0000000000000203
33. Yoshida, K., Müller, D.J. (2019). Pharmacogenetics of antipsychotic drug treatment: update and clinical implications. Molecular Neuropsychiatry, 5(Suppl. 1), 1–26. https://doi.org/10.1159/000492332
34. Sychev, D.A. (2018). An expert in personalized medicine is a specialist of the future. Pharmacogenetics and Pharmacogenomics, (2), 3–3. (In Russ.). https://www.pharmacogenetics-pharmacogenomics.ru/jour/article/view/80
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Zakharova N.V., Nasyrova R.F. Towards Personalized Psychiatry: Foreign Experience in Psychopharmacogenetics. Lex Genetica. 2025;4(2):76-93. (In Russ.) https://doi.org/10.17803/lexgen-2025-4-2-76-93
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