What is Personalized Treatment?

How to Apply Personalized Treatment?

The variation in drug metabolism among individuals can lead to insufficient response to treatment or an excess of side effects. Considering the genetic makeup of individuals, the concept of personalized psychiatry has emerged to administer the most effective and least side-effect-inducing medication at the correct dosage for each patient. Methods used to personalize pharmacological treatment can be classified as therapeutic drug monitoring (TDM), phenotyping, and genotyping (pharmacogenetics).

TDM involves monitoring drug plasma concentration, phenotypic analyses assess the activities of enzymes involved in drug metabolism, and genotypic analyses aim to identify polymorphisms in proteins such as enzymes, carrier proteins, receptors, etc. This article reviews personalized psychopharmacological treatment approaches.

Nalimov A, Akkaş Ö, Eryılmaz G. Personalized treatment approaches in psychiatry. In: Küsdül Sağlam E, editor. Personalized Treatment Approaches. 1st ed. Ankara: Türkiye Klinikleri; 2023. p.32-9.

Personalized treatment begins by fully understanding the individual's genetic, biological, psychological, and social characteristics. It addresses not only a specific illness but the overall health condition of the individual. In contrast to traditional medical approaches, the perspective of 'There is no disease, there is an ill person' integrates the individual's physical, psychological, and social needs. This approach focuses on factors such as the individual's genetic makeup, lifestyle, and emotional state, aiming to create a personalized treatment plan.

In this context, personalized treatment tailors healthcare services or treatment plans to the unique needs, characteristics, medical history, and life circumstances of the individual. Every individual has different genetic, biological, psychological, and social features, making personalized treatment involve a thorough understanding of the individual and adopting an approach tailored to them.


The Aim of Pharmacogenetics in Personalized Treatment

Each individual's genetic code is unique, and these genetic differences determine susceptibility to diseases, response to treatment, and potential side effects. Genetic-based personalized treatment involves creating a specific treatment plan based on patients' genetic profiles. This allows the adaptation of treatment to the individual based on genetic factors, potentially providing patients with access to more effective and less side-effect-prone treatments.

The strong connection between genetic-based personalized treatment and clinical pharmacogenetic laboratories ensures the successful implementation of customized treatment plans based on patients' genetic profiles. This approach aims to improve patients' response to treatment and minimize potential side effects that may arise during treatment. Pharmacogenetic studies and the applied personalized treatment methods help overcome trial-and-error approaches.

Knowing an individual's genetic map prevents the arbitrary use of drugs in treatment. Genetic-based treatment and pharmacogenetic laboratories can open doors to more effective management of diseases and further discoveries in personalized healthcare. These developments, by allowing unprecedented precision in the healthcare sector, can significantly enhance patients' quality of life through successful treatments.


In Personalized Treatment, Drug Blood Level Monitoring (TDM)

NPİSTANBUL Hospital has established a Clinical Pharmacogenetics laboratory for therapeutic drug monitoring (TDM) and determining genetic profiles. This laboratory has developed methods using desipramine as an internal standard and LC-MS/MS equipment to measure the quantity of various drugs in citrated human plasma, in accordance with 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 drugs that are metabolized rapidly or slowly. Additionally, it assists in detecting differences in drug-blood concentrations in patients with genetic polymorphism issues, allowing for early intervention and reducing the need for long-term genotyping.

By optimizing the patient's treatment process, this method can shorten hospital stays and minimize drug usage. It is particularly effective in cases where the desired response is not achieved despite treatment and in early detection of toxic effects. However, it has not been fully integrated into daily clinical practice. Utilizing TDM as a tool to adjust drug dosage based on the patient's personal characteristics is an effective way to optimize psychopharmacotherapy.


TDM Drug Plasma Level Monitoring

Pre-diagnosis of genetic polymorphism is made by examining drug plasma levels (TDM). If the drug levels in the blood plasma are not within the therapeutic range, effective treatment may not occur. Moreover, monitoring drug usage by tracking plasma levels is crucial for ensuring safe treatment.


Personalized Treatment in Psychiatry

Personalized treatment methods in psychiatry refer to treatment plans designed to suit the unique psychological and emotional state of the individual. Since each individual's life experiences, personality traits, traumas, and emotional needs vary, standard treatment methods may not be suitable for everyone.


This approach comprehensively evaluates factors that impact an individual's mental health and personalizes the treatment. Some reasons for the need for personalized treatment methods in psychiatry are as follows:

Individual Uniqueness: Each individual's psychological condition is unique. Personalized treatment focuses on the individual's specific needs and experiences.

Personality Differences: Variations in personality among individuals may require the adaptation of a treatment plan for the individual. For example, a more structured therapy approach 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: Past traumas and experiences significantly influence psychological health. Personalized treatment can specifically focus on these past experiences and traumas.

Engagement and Motivation in Treatment: The individual's engagement and motivation in the treatment process are crucial for successful therapy. Personalized treatment plans can be designed to increase the individual's motivation and ensure more effective participation in the treatment.

Emotional Needs: Each individual has different emotional needs. Personalized treatment provides support and guidance tailored to the individual's emotional needs.

Treatment Response and Healing Rate: Responses to treatment and the speed of recovery can vary significantly among individuals. Personalized treatment can be customized to ensure a better response to treatment for the individual.

Therefore, in the field of psychiatry, the goal is to support individuals more effectively and in a customized manner by using personalized treatment methods due to these reasons.


Diagnosis and Assessment in Personalized Treatment

The process of diagnosis and assessment in personalized treatment involves a comprehensive understanding of an individual's genetic, biological, psychological, and social characteristics. This process may include the following steps:

Genetic Profile Analysis: Detailed examination of an individual's genetic makeup to identify genetic predispositions.

Evaluation of Biological Factors: Understanding the biological dimension of a condition through laboratory tests, imaging methods, and analysis of biochemical parameters.

Psychosocial Assessment: A comprehensive evaluation of an individual's psychological state, social environment, lifestyle, and emotional well-being.

Medical History and Symptom Analysis: In-depth analysis of an individual's past medical history, family background, and a detailed examination of current symptoms.

Personalized Tests and Protocols: Application of specific tests to understand an individual's unique condition and the creation of customized treatment protocols.

Advanced Imaging Techniques: Utilization of advanced imaging methods to delve into diseases in a more detailed manner.

Risk Assessment: Evaluation of disease risk based on genetic and biological factors.

Patient Participation and Feedback: Active involvement and feedback from the individual in the treatment process, a crucial aspect of the diagnosis and assessment.

Education and Information: Providing necessary education and information to help the individual understand the disease, treatment options, and the personalized treatment plan.

Continuous Monitoring and Updates: Regular review of the treatment plan based on the individual's response and updating it as per evolving needs.


Personalized Treatment Methods

Personalized treatment methods can vary based on an individual's genetic, biological, psychological, and social characteristics, tailored to a customized treatment plan. Some common personalized treatment methods may include:

Genetic Analysis and Targeted Therapies: Evaluation of an individual's genetic profile, considering genetic predispositions, variations, drug metabolism differences, and drug side effect profiles. Based on these analyses, targeted treatments such as personalized medications or gene therapies can be planned.

Individualized Drug Therapy: Medications determined based on an individual's genetic profile play a significant role in personalizing treatment. Drug dosages and types can be adjusted according to the individual's response. In cases requiring multiple medications, a personalized program can be implemented.

Personalized Diet and Nutrition Programs: Customized diet and nutrition programs can be created, taking into account an individual's genetic makeup and health condition. This may include considerations for metabolism type, food intolerances, and overall health goals. Additionally, dietary habits that need modification based on individuals' genetic makeup and medications they are taking can be reviewed.

Individual Psychotherapy and Counseling: Personalized psychotherapy and counseling services can be provided, considering an individual's psychological state, personal experiences, and emotional needs.

Exercise and Physical Activity Programs: Tailored exercise and physical activity programs can be developed based on an individual's physical health, genetic factors, and lifestyle.

Health Coaching and Monitoring: Personalized health coaching and regular monitoring processes can be implemented to assist individuals in achieving their health goals.

Lifestyle Changes: Personalized lifestyle changes can be recommended based on an individual's genetic, biological, and psychosocial characteristics. This may focus on factors such as smoking cessation, regular exercise, weight management, and sleep patterns.

Personalized treatment methods involve a comprehensive understanding of the individual and a tailored approach to meet their unique needs. These methods contribute to more effective management of diseases and the improvement of overall health.

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