Matching Drug and Dose to Individual Patient

The significant recent advances in genetics and molecular neurobiology have led to considerable enthusiasm about the potential application of these strategies to improve schizophrenia treatment. Given the significant interindividual variation in response to antipsychotic drug treatment, a variety of pharmacogenetic studies are being conducted (Otani and Aoshima, 2000). While many such studies have focused on prediction of response to clozapine and other treatments, other molecular genetic investigations are directed at predicting side effects of antipsychotic treatment, such as tardive dyskinesia. Efforts to predict the optimal dose of different antipsychotics based on such studies are increasingly common.

Genomic advances also provide a powerful technique to dissect the heterogeneity of schizophrenia. Most experts believe that schizophrenia is not one disease but many distinct diseases with overlapping symptomatology. Advances in genomics will facilitate the identification of gene products involved in the pathophysiology of schizophrenia and thereby enable the development of specific therapeutic agents directed at such "disease-specific" targets. While these techniques have great potential, their specific application toward improving treatment of schizophrenia is still at a preliminary stage, and it appears unlikely that any major mainstream clinical application based on this approach is likely to become available for a decade.

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