Neuropsychiatric Disease and Treatment (May 2024)
On the Road to Individualizing Pharmacotherapy for Adolescents and Adults with Schizophrenia – Results from an Expert Consensus Following the Delphi Method
Abstract
Daniel Guinart,1– 3 Andrea Fagiolini,4 Paolo Fusar-Poli,5– 8 Giulia Maria Giordano,9 Stefan Leucht,10 Carmen Moreno,11– 13 Christoph U Correll3,14– 16 1Institut de Salut Mental, Parc de Salut Mar, Barcelona, Spain; 2Hospital Del Mar Research Institute, CIBERSAM, Barcelona, Spain; 3Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; 4Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy; 5Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; 6Department of Psychosis Studies, King’s College London, London, UK; 7Outreach and Support in South-London (OASIS) Service, South London and Maudsley (Slam) NHS Foundation Trust, London, UK; 8Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany; 9Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy; 10Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany; 11Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (LISGM), Madrid, Spain; 12Centro de Investigación Biomedica en Red (CIBERSAM), ISCIII, Madrid, Spain; 13School of Medicine, Universidad Complutense, Madrid, Spain; 14Department of Psychiatry, The Zucker Hillside Hospital, New York, NY, USA; 15Department of Child and Adolescent Psychiatry, Charité Universitatsmedizin, Berlin, Germany; 16German Center for Mental Health (DZPG), Partner Site, Berlin, GermanyCorrespondence: Christoph U Correll, Department of Psychiatry, The Zucker Hillside Hospital, 75-59 263rd Street Glen Oaks, New York, NY, 11004, USA, Email [email protected]: Schizophrenia is a severe mental illness that usually begins in late adolescence or early adulthood. Current pharmacological treatments, while acceptably effective for many patients, are rarely clinically tailored or individualized. The lack of sufficient etiopathological knowledge of the disease, together with overall comparable effect sizes for efficacy between available antipsychotics and the absence of clinically actionable biomarkers, has hindered the advance of individualized medicine in the treatment of schizophrenia. Nevertheless, some degree of stratification based on clinical markers could guide treatment choices and help clinicians move toward individualized psychiatry. To this end, a panel of experts met to formally discuss the current approach to individualized treatment in schizophrenia and to define how treatment individualization could help improve clinical outcomes.Methods: A task force of seven experts iteratively developed, evaluated, and refined questionnaire items, which were then evaluated using the Delphi method. Descriptive statistics were used to summarize and rank expert responses. Expert discussion, informed by the results of a scoping review on personalizing the pharmacologic treatment of adults and adolescents with schizophrenia, ultimately generated recommendations to guide individualized pharmacologic treatment in this population.Results: There was substantial agreement among the expert group members, resulting in the following recommendations: 1) individualization of treatment requires consideration of the patient’s diagnosis, clinical presentation, comorbidities, previous treatment response, drug tolerability, adherence patterns, and social factors; 2) patient preferences should be considered in a shared decision-making approach; 3) identified barriers to personalized care that need to be overcome include the lack of actionable biomarkers and mechanistic similarities between available treatments, but digital tools should be increasingly used to enhance individualized treatment.Conclusion: Individualized care can help provide effective, tailored treatments based on an individual’s clinical characteristics, disease trajectory, family and social environment, and goals and preferences.Keywords: psychosis, psychopharmacology, treatment, personalized, psychiatry
