TORONTO — While biomarkers are often talked about extensively in other areas of medicine as a way to predict the potential onset of a disease, the use of them in psychiatry is much more limited — so far. However, that is quickly changing as ongoing psychiatric research into biomarkers is making it possible to determine which antipsychotic drug may be most effective for a schizophrenia patient and can also provide a more concrete diagnosis beyond what a clinical interview can provide.
For example, genetic variation in certain genes, such as the dopamine d2 receptor gene, appears to predict the efficacy of antipsychotic drugs, according to Anil Malhotra, MD, director of psychiatry research at Zucker Hillside Hospital in Glen Oaks, New York.
Malhotra, who spoke with Psychiatry Advisor prior to participating in a symposium on the potential of biomarkers to assist in clinical care at the American Psychiatric Association Annual Meeting, added that he has done other research that suggests it may be possible to predict side effects associates with antipsychotics. Two of those side effects are clozapine-induced agranulocytosis — a blood dysplasia — and weight gain associated with second-generation antipsychotics.
“In both cases, we’ve attempted to identify genetic variants for patients who are predisposed to those side effects, he said” The genes identified are the melanocortin 4 receptor (mcr4) for weight gain and for agranulocytosis, hladqb1, which is an immune-related gene.
Biomarkers hold much promise in the treatment of psychiatric disorders, according to Malhotra, because of the trial-and-error method of trying different antipsychotics until finding the one that works for a particular patient. If a clinician could know right off the bat which drug would work best, it would accelerate improvement in the patient.
In essence, biomarkers are psychiatry’s way of getting into precision medicine, a growing trend in medicine. “What we’re trying to do with this research is personalize treatments with genetics biomarkers…so we can identify the best treatments for individual patients.”
Other research indicates that blood proteins may also play a role in psychiatric disorders and are potential biomarkers. Sabine Bahn, MD, PhD, director of the Cambridge Center for Neuropsychiatric Research at the University of Cambridge in the United Kingdom, and colleagues have examined brain tissue from people diagnosed with schizophrenia, as well as cerebrospinal fluid, and found abnormalities in protein expression in peripheral blood.