[Farmacogenetica in de psychiatrie; de huidige status quo]. / Farmacogenetica in de psychiatrie; de huidige status quo.

BACKGROUND: Medication side effects and limited efficacy are substantial problems in general and also in psychopharmaceuticals. Previous studies have shown that pharmacogenetic individual characteristics can be relevant. AIM: To arrive at a responsible use of pharmacogenetics, exploiting its potential but also avoiding overdiagnosis. METHOD: To provide an overview of the current status quo in the field of pharmacogenetics in psychiatry. RESULTS: The Dutch Association for Psychiatrists (NVvP) authorized a guideline ‘Pharmacogenetics in Psychiatry’ that is summarized. Also the current international guidelines and clinical implementation of pharmacogenetics are discussed. CONCLUSION: For the time being, pharmacogenetics seems to be indicated only when patients have already experienced problems with psychopharmaca use, such as side effects and/or inefficacy. If genotyping is requested then generally CYP2C19 and CYP2D6 can be useful, as dosage recommendations are available in case of genetic variants.

[The subclinical course of a paracetamol intoxication: pitfall for patient and clinician]. / Het subklinische beloop van een paracetamolintoxicatie: valkuil voor patiënt en behandelaar.

A 24-year-old man took 20 grams of paracetamol during a hospital stay in the department of psychiatry. It was not until 60 hours later that therapy with acetylcysteine was initiated. Paracetamol intoxication has a long latency period. If there is no intervention, severe hepatic damage can develop within three days. Even after a few days have passed it is still advisable to start treating the patient with acetylcysteine.

Policy and Practice Review: A First Guideline on the Use of Pharmacogenetics in Clinical Psychiatric Practice.

Effective pharmacologic treatments for psychiatric disorders are available, but their effect is limited due to patients' genetic heterogeneity and low compliance-related to frequent adverse events. Only one third of patients respond to treatment and experience remission. Pharmacogenetics is a relatively young field which focusses on genetic analyses in the context of the metabolism and outcome of drug treatment. These genetic factors can, among other things, lead to differences in the activity of enzymes that metabolize drugs. Recently, a clinical guideline was authorized by the Dutch Clinical Psychiatric Association (NVvP) on the clinical use of pharmacogenetics in psychiatry. The main goal was to provide guidance, based on current evidence, on how to best use genotyping in clinical psychiatric practice. A systematic literature search was performed, and available publications were assessed using the GRADE methodology. General recommendations for psychiatric clinical practice were provided, and specific recommendations per medication were made available. This clinical guideline for caregivers prescribing psychotropic drugs is the product of a broad collaboration of professionals from different disciplines, making use of the information available at the Dutch Pharmacogenetics Working Group (DPWG) and the Clinical Pharmacogenetics Implementation Consortium (CPIC) so far. We summarize the relevant literature and all recommendations in this article. General recommendations are provided and also detailed recommendations per medication. In summary we advise to consider genotyping, when there are side effects or inefficacy for CYP2C19 and CYP2D6. When genotype information is available use this to select the right drug in the right dose for the right patient.