Clinical Utility of Pharmacogenomics of Psychotropic Medications
Status:
Unknown status
Trial end date:
2021-02-01
Target enrollment:
Participant gender:
Summary
While the scientific understanding of pharmacogenomics is quickly accelerating, its
translation to clinical decision-making (especially in psychiatric practice) has progressed
more slowly. In an effort to begin to bridge this translational gap, genetic testing has been
developed for various and commonly existing psychiatric disorders, such as major depression,
schizophrenia, bipolar disorder, and pain syndromes to improve the safety of prescribing
psychotropic medications for these disorders. This genetic testing incudes several
pharmacodynamics and pharmacokinetic genetic factors, such as the cytochrome P450 1A2 gene
(CYP1A2); the cytochrome P450 2B6 (CYP2B6) gene; P450 2D6 gene (CYP2D6); the cytochrome P450
2C9 gene (CYP2C9); the cytochrome P450 2C19 gene (CYP2C19); uridine-glucoronyl-transferase
2B15 (UGT2B15) gene; the serotonin transporter gene (Solute Carrier Family 6 Member; SLC6A4);
p-glycoprotein ( ATP-binding cassette sub-family B member 1; ABCB1) transporter gene; the
serotonin 2A receptor gene (HTR2A); the serotonin 2C receptor (HTR2C) gene; serotonin 1a
receptor (5HT1a) gene; dopamine 1 receptor (DRD1) gene; dopamine 2 receptor (DRD2) gene;
adrenergic alpha-2A receptor (alpha-2A) gene; opioid mu (opioid receptor mu 1; OPRM1)
receptor gene; dopamine synthesis gene (ankyrin repeat and kinase domain containing 1;
ANKK1); dopamine metabolizing enzyme [Catechol-o-methyltransferase (COMT]) gene; kainite
receptor gene (glutamate ionotropic receptor kainate type subunit 4; GRIK4); folate
(methylenetetrahydrofolate reductase; MTHFR) gene; sodium channels (sodium voltage-gated
channel alpha subunit 2; SCN2A) gene.
The interpretive report is based on copies of these multiple informative genes. The
investigators are proposing to utilize comprehensive genetic testing to select more
genetically-informed psychotropic medications to enhance their effectiveness in real-world
patients with psychiatric illnesses such as schizophrenia, major depression, bipolar
affective disorder as well as pain in a state hospital setting. The investigators plan to use
genetic testing offered by Admera® for major classes of psychotropic medications. The
investigators hypothesize that genetic testing will demonstrate clinical benefits by
improving state hospital patients' response and decreasing their adverse effects. The
proposed study will be conducted in a total sample of 60 subjects diagnosed with
schizophrenia, major depression, bipolar affective disorder as well as pain at the Oregon
State Hospital, Salem Oregon over a total period of 24 months