Psychopharmacology of Schizophrenia?

The inherent wide interindividual variability in response and tolerability of side effects in the treat-ment of schizophrenia itself provides a compelling rationale for the great potential of pharmacoge-netics. Moreover, this potential is consonant with the broader public health directive toward per-sonalized medicine. Within schizophrenia, the progress thus far has been modest in both the treatment response and adverse effect domains. This chapter chronicles the progress made in the quest for pharmacogenetic predictors in the treatment of schizophrenia. Copyright © 2010 S. Karger AG, Basel By any measure – and especially with regard to its treatment – schizophrenia is a highly heterogeneous disorder. A continued debate in our field that is of great rele-vance to the area of pharmacogenetics is whether schizophrenia is actually etiologi-cally heterogeneous – that is a collection of several conditions that arise from different pathobiological bases – or whether schizophrenia is (merely) symptomatically hetero-geneous [1]. Certainly, every clinician knows well that the presentation and course of illness varies widely between patients. Irrespective of whether you ascribe this hetero-geneity to neurobiology or course alone, this variability in schizophrenia itself is the ‘baseline condition ’ upon which pharmacogenetic examinations begin. This is an im-portant consideration. Clinicians also know that there is wide variability in patients ’ response and toler-ability of any given antipsychotic medication. The advent of second-generation anti-psychotic medications (SGAs) alongside the first-generation antipsychotic medica-tions (FGAs) has broadened the treatment options for patients. However, in large part the dilemma remains the same: at present, the selection of an antipsychotic is more on a ‘trial and error ’ basis rather than based upon any robust rationale. Pharmacogenetics of Schizophrenia: Bringing ‘Order to Chaos ’ in th