SLOVAK PSYCHIATRISTS‘PERSPECTIVE ON THE ROLE OF PHARMACOGENETIC TESTING IN MENTAL HEALTH CARE
Authors: Krivosova *Michaela , Hutka Peter , Hrtanek Igor , Ondrejka Igor , Maggioni Laura , Marcatili Matteo , Clerici Massimo , Mokry Juraj 
Published: February 2025

Abstract

Background
In the shadow of global pandemics of COVID-19, a new silent one concerning mental health is emerging. The complete understanding of the pathophysiology of mental diseases remains elusive, resulting in insufficient remission, frequent incidence of adverse drug reactions as well as resistance to treatment. While a vast number of affected individuals worldwide do not have access to effective mental disorder care, treatment resistance affects 20-60% patients.1 A personalized approach has been recently incorporated to the therapy also in psychiatry and one of the strategies is pharmacogenetic (PGx) testing, which has the potential to guide effective drug therapy and minimize side effects.

Aims & Objectives
The objective of this study was to assess the viewpoints of Slovak psychiatrists regarding the integration of PGx testing in psychiatric clinical practice.

Method
Questionnaires were distributed directly to attendees at two psychiatric conferences held in Slovakia in 2023. The questionnaires were designed to be anonymous and were structured based on research conducted by a collaborative team in Italy. They covered various aspects, including basic demographic information, prior experience with PGx testing, self-perceived competence in PGx, perceived utility, potential risks, and challenges, as well as the participants' willingness to expand their knowledge about the application of PGx in psychiatry. The questionnaire is currently available online and was shared within the Slovak psychiatric community.

Results
Out of 60 directly approached conference participants we received 53 responses as 5 individuals declined to participate because of the questionnaire topic and 2 reported time constraints. Our respondents were from various age groups, the majority were females (66%) and had different backgrounds such as psychiatrists for adults (45.3%), pedopsychiatrists (15.1%), clinicians with expertise in both areas (3.8%), residents in a psychiatry program (20.7%) or pharmacists and researchers working in the field of psychiatry (15.1%). Only 4 participants (7.5%) had previous experience with PGx testing in psychiatric clinical practice and only 3 claimed its clinical benefit. The data indicated that 88.7% of participants believed it was their responsibility to provide PGx testing to their patients, but only 41.5% felt confident in their ability to do so. Based on the responses, 64.2% of attendees thought that PGx would be very or extremely useful in selection of medication, 62.3% in drug intolerance and adverse reactions, 56.6% in dosing adjustment, 66.0% in treatment resistant depression, 62.3% in treatment resistant schizophrenia, and 60.4% in resistant obsessive-compulsory disorder. The most significant concerns expressed were the absence of standards or guidelines (77.4%) and the cost of the tests (64.2%). Notably, 84.9% of the participants indicated their eagerness to acquire further knowledge about the integration of PGx in psychiatric clinical practice.

Discussion & Conclusion
The results of this questionnaire found that most clinicians felt that they should possess the skills to apply PGx testing in psychiatric clinical practice and were enthusiastic about increasing their expertise. The primary concerns centered around the lack of well-defined guidelines and the financial considerations linked to the testing.
The study was supported by grants VEGA-1/0145/22 and APVV-22-0342.

References
1.Howes, O.D., Thase, M.E. and Pillinger, T. (2021). Treatment resistance in psychiatry: state of the art and new directions. Molecular Psychiatry, 27(1). doi:https://doi.org/10.1038/s41380-021-01200-3.