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Review
. 2021 Sep 22:12:740216.
doi: 10.3389/fgene.2021.740216. eCollection 2021.

What Are the Barriers and Enablers to the Implementation of Pharmacogenetic Testing in Mental Health Care Settings?

Adam Jameson  1   2   3 , Beth Fylan  2   3   4 , Greg C Bristow  2 , Gurdeep S Sagoo  5   6 , Caroline Dalton  7 , Alastair Cardno  8 , Jaspreet Sohal  1 , Samantha L McLean  2   3
Affiliations
Review

What Are the Barriers and Enablers to the Implementation of Pharmacogenetic Testing in Mental Health Care Settings?

Adam Jameson et al. Front Genet. .

Abstract

In psychiatry, the selection of antipsychotics and antidepressants is generally led by a trial-and-error approach. The prescribing of these medications is complicated by sub-optimal efficacy and high rates of adverse drug reactions (ADRs). These both contribute to poor levels of adherence. Pharmacogenetics (PGx) considers how genetic variation can influence an individual's response to a drug. Pharmacogenetic testing is a tool that could aid clinicians when selecting psychotropic medications, as part of a more personalized approach to prescribing. This may improve the use of and adherence to these medications. Yet to date, the implementation of PGx in mental health environments in the United Kingdom has been slow. This review aims to identify the current barriers and enablers to the implementation of PGx in psychiatry and determine how this can be applied to the uptake of PGx by NHS mental health providers. A systematic searching strategy was developed, and searches were carried out on the PsychInfo, EmBase, and PubMed databases, yielding 11 appropriate papers. Common barriers to the implementation of PGx included cost, concerns over incorporation into current workflow and a lack of knowledge about PGx; whilst frequent enablers included optimism that PGx could lead to precision medicine, reduce ADRs and become a more routine part of psychiatric clinical care. The uptake of PGx in psychiatric care settings in the NHS should consider and overcome these barriers, while looking to capitalize on the enablers identified in this review.

Keywords: mental health; pharmacogenetic testing; pharmacogenetics; pharmacogenomics; psychiatry.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Adapted from Bousman C. et al. (2019) and information presented on https://www.pharmgkb.org/- a network analysis detailing common psychotropic drugs with their associated pharmacogenes. CYP2D6 and CYP2C19 are common metabolic pathways for a range of antidepressants and antipsychotics. Also noted is the drug-gene interaction between HLA-B and Phenytoin/Carbamazepine, a well-documented pharmacogenetic interaction.
See this image and copyright information in PMC

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