University of Nantes, Department of Pharmacology, 98, rue Joseph Blanchart 44100 Nantes, France , E-mail; firstname.lastname@example.org
Citation: Michel Bourin (2016) Future in Psychopharmacology. KJ Pharmacol 1: 100104
Copyrights: Â© 2016 Michel Bourin
Over the last 10–15 years, there has been important change in psychopharmacology. The study of psychiatric disorders is now fully based in the basic neurosciences, and biological psychiatry is now synonymous with the study of basic neurobiological phenomena and their relation to illness and treatment response. Moreover, basic neuroscience phenomena are also studied, at least as they apply to psychiatric illness, in the context of social learning, developmental stage and culture. The brain is the transducer of many environmental phenomena, including stress, and stress and other stimuli mediated by the brain affect a wide variety of organs, including the brain itself. Therefore, the brain is not only the transducer but also the effector of stress, one consequence of which may be increased vulnerability to psychiatric illness. Integration of the understanding of environmental events and their impact on biology, particularly brain biology, involves studies at the most basic level. Progress in this area will ultimately unlock the secrets of the biology of major psychiatric illness and the mechanism of action of the drugs that are effective in treating them.
The emergence of precise targets of drugs in the brain with the help of binding studies was a great progress in the discovery of new drugs and the beginning of the knowledge of mechanisms of action. But the main challenge is to understand the correlates on the different areas of brain and on the entire body.
Significant inter-individual variability exists in psychotropic drugs response, therapeutic dosage, and adverse effect profile. Prolonged times to response or remission represent a period of suffering associated with an increased risk for morbidity and mortality. Improving care in psychiatric treatments using a more biologically unformed selection of psychopharmacologic agents through genotyping has become a reality in clinical psychiatry. Routine genotyping has now become available for gene variations that code for proteins involved in neurotransmission and for drug-metabolizing enzymes involved with the disposition of many pharmacologic agents. Clinical validation and reliability of genotyping, access to testing, uniformity and clarity in test interpretation, and clinician and patient education are critical to this process of innovation diffusion.
2. How can personalized medicine be applied to psychiatry?
How to improve the course of illness with earlier diagnosis and prevention measures?
-How to close the gap between evidence based medicine and effective care?
- How to improve adequate monitoring of medical risk factors and co morbid conditions?
The precedent questions are the same for all psychiatric disorders we have to cure. More and more the international societies will provide clinicians with strategies of personalized medicine.
The US FDA has granted market approval for the first pharmacogenetic test using a DNA microarray, the AmpliChip CYP450, which genotypes cytochrome P450 (CYP) 2D6 and CYP2C19. The test uses software to predict phenotypes and tests for 27 CYP2D6 alleles, including the deletions and duplications, and three CYP2C19 alleles. Other DNA microarray platforms are being developed for CYP testing, but none have been completely developed or approved by the FDA to date.
The genotyping based personalized psychiatry is now on the way. The most promising pathway is a first short-term measure genotyping patients for CYP2D6 which metabolizes the large extent of current antidepressants and antipsychotics would prove to be of the highest potential. This seems factual both in terms of reduced patient morbidity and mortality, and overall costs to the healthcare system.
Thus, the molecular-based and circuit-based advances in psychiatry can, at last, be translated into personalized medicine. This would be an advance to better treat patients as well to improve our knowledge in psychiatric diseases.
Today, it is easy to envision a future where psychiatric diagnosis is based on understanding fundamental defects in thinking, emotional processing, and motivational systems. In such a world, our traditional categories of psychotic disorders, mood disorders, anxiety disorders, cognitive disorders, and even personality disorders may need to be completely revised. In addition to the work on dementias, current research on the biology of syndromes associated with mental retardation is a great example of the potential opportunities.
One of the strongest reasons we are optimistic about the future of psychiatry is the recent rate of progress in all of biomedical research. We have alluded to the major advances in genetics, molecular biology, neurobiology, and cognitive sciences that have taken place since the late 1980s. Psychiatry is especially well positioned to take advantage of these advances and to build on them.