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Yıl:2010; Cilt: 20; Sayı: 4>> Özet
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Klinik Psikofarmakoloji Bülteni; 2010;20(4):269-273
Psikiyatride bireye özgü tedavi: Belki biraz eski veya biraz yeni, ama geleceğin tedavisi
F Arıcıoğlu, M Çetin
Marmara Ü. Tıp Fak.
Günümüzde kullanılan ilaçların çoğu güvenlik ve etkinliği geniş kitleler üzerinde değerlendirilerek geliştirilen ve onaylanan, her biri tanılarına göre tüm hastalara reçete edilebilen ilaçlardır. Son yıllarda psikotrop ilaçların sayılarının artmasına rağmen, psikiyatrik bozuklukların tedavilerinde etkinlikleri hala tatminkar düzeyde değildir. Üstelik bu ilaçlar kendilerine verilen bireylerde kayda değer bireysel değişkenlik göstermektedirler. Bu nedenle son yıllarda ‘bireye özgü tedavi’ kavramı geliştirilmiştir. Bireye özgü tedavinin gelişmesi ile ilişkili çok sayıda faktör olmasına rağmen moleküler biyoloji alanındaki gelişmeler çok daha önemli role sahiptir. Genetik ve moleküler biyoloji alanındaki araştırmalara dayanan bireye özgü tedavi kavramı, psikofarmakolojinin çözüm bekleyen en önemli konusu haline gelmiştir. Tek nükleotid polimorfizminin bireyler arasında ilaca cevap farklılığına sebep olduğu bilinmekle birlikte, şizofreni, major depresyon ve bipolar bozuklukluğun da dahil olduğu bir çok psikiyatrik bozukluk etyolojik olarak poligenik kabul edilir. Geriye dönük olarak bulgular toplu olarak değerlendirildiğinde de, psikiyatride terapötik doz ayarlanması, yanıt öngörme, advers ilaç reaksiyonlarını azaltma, erken tanı ve kişisel sağlık planlaması bireye özgü tedaviyi daha da destekler yöndedir. Özetle, “hastalığı değil, hastayı tedavi etmek” olarak da tanımlanan bireye özgü tedavi, yönerge, protokol ve algoritmalar çağı olarak bilinen günümüz psikiyatrisinde kolaylıkla üstesinden gelinebilecek bir durum değildir.
Personalized drug therapy in psychiatry: Maybe a little old or a little new, but the treatment of future
Most of current drugs are developed and approved on the basis of their safety and effectiveness in large group of people and they can be prescribed to any patient based on the diagnosis. Despite increased number of available psychotropic drugs today, these drugs are still not enough to treat the whole spectrum and severity of psychiatric disorders. Besides, they show significant individual variations among patients. Because of that the concept of personalized therapy has been developed in recent [year]s. Among many factors that have contributed to the development of personalized drug therapy, it is thought that advances in the molecular biology have played the most significant role so far. The concept of personalized drug therapy, which relies on genetic and molecular biology research, has become the most important issue in psychopharmacology. Although single nucleotide polymorphisms are known to cause variations in drug responsiveness among individuals, most psychiatric disorders, including schizophrenia, major depression, and bipolar disorder, are considered polygenic in etiology. Retrospective evaluation of the data up to date provides further support for personalized drug therapy in psychiatry in adjusting therapeutic doses, predicting responses, reducing adverse drug reactions, making early diagnoses, and developing personal health plans. In summary, personalized drug therapy, which can also be expressed as “treat the patient, not the disease” is not an easy task in the era of guidelines, protocols, and treatment algorithms.

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