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Book Reviews   |    
Pharmacogenetics of Psychotropic Drugs
Reviewed by Calvin R. Sumner, M.D.
Psychiatric Services 2004; doi: 10.1176/appi.ps.55.1.93
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edited by Bernard Lerer; New York, Cambridge University Press, 2002, 446 pages, $130

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Pharmacogenetics is one of the latest hot topics in psychopharmacology, and Bernard Lerer has compiled an excellent overview of the subject in his new text, Pharmacogenetics of Psychotropic Drugs. Lerer has edited the work of 46 leading neuroscientists into 21 concise chapters defining for clinicians and researchers the young field of pharmacogenetics as it applies to psychotropic drugs. Lerer has authored the introductory section himself, describing the practical and theoretical foundations that organize the field of pharmacogenetics and the contents of this book. He takes the reader through a brief overview of the rationale for pharmacogenetics, a developmental history, a definition of current terms and techniques, an articulation of the core issues in pharmacogenetic research, the relationship between pharmacokinetics and pharmacogenomics, and the realistic implications for future pharmaceutical development.

The 20 chapters that follow are divided into six sections that roughly parallel the framework Lerer outlines in the introduction. The second section includes four chapters elaborating the research and statistical methods of modern pharmacogenetics and the critical discoveries that link this science to the study of genetically determined interindividual differences in response to drugs. Of particular interest in this section is a chapter by Thomas A. Ban on the inherent difficulties in using current phenotypically driven nosologies in the conduct of genetic research. Ban's optimistic conclusion is that current nosologies will serve as a starting point for the development of a new empirically derived pharmacologically meaningful classification of mental illness.

Sections 3 and 4 focus on specific genetic differences that found early application in improving our understanding of interindividual variability in drug actions, pharmacokinetics, responses, and side effects. Throughout these sections, the authors emphasize that pharmacogenomics, in general, will not improve the efficacy of a given drug but that pharmacogenetic profiling may assist the selection of patients who are likely to respond favorably. Technical discussions of the application of pharmacogenetics to specific diseases and specific categories of drugs unify the nine chapters in section 5. These chapters are fairly complex and will present a challenge to readers who are not familiar with pharmacogenetics. Certainly, this section will test how well the reader has assimilated the information from the preceding sections. Section 6 relates the pharmacogenetic findings discussed in the previous section and relates this information to emerging technologies in brain imaging applied to schizophrenia and Alzheimer's disease. In the seventh and concluding section, William Z. Potter and colleagues consider the potential applications of pharmacogenetic progress in the industry of drug discovery and development.

The few limitations of the book relate to the difficulties in summarizing an impressive body of science succinctly for readers with varying knowledge bases. Overall, this book provides a conceptual overview of pharmacogenetics illustrated with significantly technical examples from clinical and research experience. Pharmacogenetics of Psychotropic Drugs is appropriate for both neophytes and advanced practitioners and is an excellent introduction for anyone trying to bridge the conceptual gap between the genetics most of us learned and the emerging field of pharmacogenetics.

Dr. Sumner is with Eli Lilly & Company in Indianapolis.

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