858. Implementation of Pharmacogenetics in Psychiatry across the world: Australasia

Abstract

Abstract Background The case presented comes from a recently completed randomized controlled trial of pharmacogenomic guided prescribing as part of inpatient treatment of mood disorders. Consecutive adult inpatients with any primary mood disorder diagnosis admitted to Ramsay Clinic Albert Road, a private inpatient psychiatric hospital in Melbourne Australia were randomized to receive Amplis Evo pharmacogenomic testing at either the point of admission or post trial, with the primary outcome being remission at 16 weeks. The case described here highlights several of the pragmatic clinical issues in the use of pharmacogenomic testing in this setting. Aims & Objectives To describe the use of pharmacogenomic testing to assist the inpatient management of treatment resistant recurrent unipolar major depression. Method AB was, at the time of admission, a 37 year old partnered woman with a history of recurrent major depression. Her current episode had failed to respond to the combination of regular psychotherapy and adequate trials of multiple antidepressants of several classes and augmentation with atypical antipsychotics. Whilst most trials were adequate, two were stopped prematurely due to side effects. Pharmacogenomic testing was performed at time of admission, with results available within 72 hours. Results Consistent with clinical need, initial change of pharmacotherapy was made within 24 hours of admission. Once testing results were available, the clinical decision was made to persist with the initially chosen course of pharmacotherapy despite some concern based on the testing. After a failure to respond, adjustment was made to therapy consistent with testing outcomes and improvement followed. Discussion & Conclusions The case highlights the potential utility of pharmacogenomic testing in the management of difficult to treat depression but equally showed some challenges in its application in an inpatient setting. Timeliness of testing and availability of results with current off site testing clearly represents a pragmatic barrier in a setting where rapid decision making is required. Provision of reports that are readily accessible and interpretable to treating clinicians in a setting where specialized advice may not always be readily available represents a second area for consideration. Ultimately point of care testing and easily sourced sub specialist support may be critical to maximize the potential opportunity.