Differences in drug metabolism between individuals may lead to inadequate response to treatment or high incidence of side effects. Considering the genetic structure of individuals, the concept of personalized psychiatry has emerged in order to administer the most effective drug with the least side effects at the correct dose. The methods used to personalize pharmacological treatment can be classified as drug blood level measurement (TDM), phenotyping and genotyping (Pharmacogenetics).
TDM monitoring is used to determine drug plasma concentration, phenotypic analysis is used to determine the activities of enzymes involved in drug metabolism, and genotypic analysis is used to determine polymorphisms in proteins such as enzymes, transporter proteins, receptors, etc. In this article, individualized psychopharmacologic treatment approaches are reviewed. In this article, individual-specific psychopharmacologic treatment approaches are reviewed.
REFERENCES
Nalimov A, Akkaş Ö, Eryılmaz G. Personalized treatment approaches in psychiatry. Küsdül Sağlam E, editor. Personalized Treatment Approaches. 1st Edition. Ankara: Türkiye Klinikleri; 2023. p.32-9.
Personalized treatment begins with a thorough understanding of the individual's genetic, biological, psychological and social characteristics. It deals with the overall health status of the individual, not just a specific disease. In contrast to conventional medicine, the 'no disease, patient' perspective brings together the physical, psychological and social needs of the individual. This approach aims to create a personalized treatment plan by focusing on factors such as the individual's genetic makeup, lifestyle and emotional state.
Accordingly, this treatment method refers to a health service or treatment plan that is customized according to the unique needs, characteristics, medical history and life circumstances of the individual. Each individual has different genetic, biological, psychological and social characteristics, so personalized treatment involves a thorough understanding of the individual and the adoption of a tailored approach.
Purpose of Pharmacogenetics in Personalized Treatment
Each individual's genetic code is unique and these genetic differences determine susceptibility to disease, response to treatment and potential side effects. Genetics-based personalized treatment involves creating a customized treatment plan based on patients' genetic profiles. This allows treatment to be tailored to the individual based on genetic factors. Thus, patients may have access to more effective treatments with fewer side effects.
The strong link between genetics-based personalized treatment and clinical pharmacogenetics laboratories enables the successful implementation of customized treatment plans based on patients' genetic profiles. This approach aims both to improve patient response to treatment and to minimize side effects that may occur during treatment. Personalized treatment methods applied with pharmacogenetic studies prevent trial-and-error methods.
Knowing the person's gene map prevents the use of rote medication in treatment. Genetics-based treatment and pharmacogenetics laboratories can open the doors to more discoveries for more effective disease management and personalized healthcare. These advances could enable treatments with unprecedented precision and success in the healthcare industry, significantly improving patients' quality of life.
Drug Blood Level (TDM) in Personalized Therapy
NPISTANBUL Hospital has established a Clinical Pharmacogenetics laboratory for therapeutic drug blood level monitoring (TDM) (Therapeutic Drug Monitoring) and genetic profiling. This laboratory has developed methods to quantify many drugs in citrated human plasma using an LC-MS/MS instrument using desipramine as an internal standard to meet the accuracy and precision limits set by the FDA. The developed method can be used as a tool to monitor unexpected side effects of drugs at normal doses and to understand fast or slow metabolized drugs. It also helps to take early action by detecting drug-blood concentration differences in patients with genetic polymorphism problems and reduces the need for long-term genotyping.
This method can optimize the patient's treatment process, shortening hospital stays and minimizing drug use. It is particularly effective in cases where there is no desired response despite treatment and early detection of toxic effects. However, it has not been fully integrated into daily clinical practice. Using TDM as a tool to adjust the drug dose according to the patient's individual characteristics is an effective way to optimize psychopharmacotherapy.
TDM Drug Plasma Level Monitoring
A preliminary diagnosis of genetic polymorphism is made by looking at the blood plasma levels of medicines (TDM). If the blood levels of the drugs are not within the therapeutic range, effective treatment will not be realized. Also, monitoring blood levels is very important for safe treatment.
Personalized Treatment in Psychiatry
In psychiatry, individualized treatment modalities refer to treatment plans that are tailored to an individual's unique psychological and emotional situation. Since each individual's life experiences, personality traits, traumas and emotional needs are different, standard treatment methods may not be appropriate for everyone.
This approach holistically assesses the factors that affect a person's mental health and personalizes treatment. Some of the reasons for the need for personalized treatment methods in psychiatry are as follows;
Uniqueness of the Individual: Each individual's psychological condition is unique. Individualized treatment focuses on the specific needs and experiences of the individual.
Personality Differences: Personality differences between individuals may require tailoring a treatment plan to the individual. For example, a more structured approach to therapy may be more effective for one person, while a more flexible and emotional approach may be more effective for another.
Impact of Trauma and Experiences: Individuals' past traumas and experiences have a significant impact on psychological health. Individualized treatment can focus specifically on these past experiences and traumas.
Treatment Participation and Motivation: The individual's participation and motivation in the treatment process is critical for successful treatment. Individualized treatment plans can be designed to increase the individual's motivation and enable them to participate more effectively in treatment.
Emotional Needs: Each individual's emotional needs are different. Individualized treatment provides support and guidance tailored to the emotional needs of the individual.
Treatment Response and Speed of Recovery: The response to treatment and speed of recovery can vary significantly between individuals. Individualized treatment can be customized to enable the individual to respond better to treatment.
For these reasons, it is aimed to support individuals in a more effective and customized way by using personalized treatment methods in the field of psychiatry.
Diagnosis and Assessment in Individualized Treatment
In personalized treatment, the diagnosis and evaluation process is comprehensive, taking into account the genetic, biological, psychological and social characteristics of the individual. This process may include the following steps:
Genetic Profile Analysis: A detailed examination of the individual's genetic structure and identification of genetic predispositions.
Assessment of Biological Factors: Understanding the biological dimension of the disease by analyzing laboratory tests, imaging methods and biochemical parameters.
Psychosocial Assessment: A comprehensive assessment of the individual's psychological state, social environment, lifestyle and emotional health.
Examination of Disease History and Symptoms: A detailed analysis of the individual's past medical history, family history and current symptoms.
Personalized Tests and Protocols: The administration of specific tests and the creation of customized treatment protocols to understand the individual's specific condition.
Advanced Imaging Techniques: The use of advanced imaging methods allows for a more detailed examination of diseases.
Risk Assessment: Assessment of an individual's risk of disease based on genetic and biological risk factors.
Patient Participation and Feedback: The active participation and feedback of the individual in the treatment process is an important element in the diagnosis and evaluation process.
Education and Information: Providing the individual with the necessary education and information to understand the disease, treatment options and personalized treatment plan.
Continuous Monitoring and Updating: Regularly reviewing the treatment plan based on the individual's response and updating it according to needs.
What are Personalized Treatment Methods?
Individualized treatment modalities can vary depending on the treatment plan, which is customized based on the individual's genetic, biological, psychological and social characteristics. Some common personalized treatment methods may include:
Genetic Analyses and Targeted Therapies: The individual's genetic profile is assessed, taking into account genetic predispositions, genetic variations, differences in drug metabolism and drug side effect profiles. Based on these analyses, targeted therapies such as individualized medications or gene therapies can be planned.
Individual Drug Therapy: Medications determined based on an individual's genetic profile play an important role in personalizing treatment. Drug dosages and types can be adjusted according to the individual's response. If multiple medications are required, a personalized program can be applied.
Personalized Diet and Nutrition Programs: Customized diet and nutrition programs can be created by taking into account the genetic structure and health status of the individual. This can be based on the individual's metabolism type, food intolerances and general health goals. In addition, dietary habits that need to be changed in terms of genetic structure and medications can be reviewed.
Individual Psychotherapy and Counselling: Customized psychotherapy and counselling services can be provided, taking into account the individual's psychological state, personal experiences and emotional needs.
Exercise and Physical Activity Programs: Exercise and physical activity programs tailored to the individual's physical health, genetic factors and lifestyle can be created.
Health Coaching and Follow-up: Personalized health coaching and regular follow-up processes can be applied to help individuals achieve their health goals.
Lifestyle Changes: Customized lifestyle changes may be recommended based on the individual's genetic, biological and psychosocial characteristics. This may focus on factors such as smoking cessation, exercising, weight control, sleep patterns.
Personalized treatment modalities involve a thorough understanding of the individual and an approach tailored to their unique needs. These methods can help manage diseases more effectively and improve an individual's overall health.