TDM and pharmacogenetics for improving psychiatric patient care: the situation in Lausanne, Switzerland

The UPPC has both clinical and research activities within the Lausanne University Department of Psychiatry. It is in charge of a pharmacogenetic and of a therapeutic drug monitoring (TDM) laboratory which measures a very large number of psychotropic drugs. All TDM results are processed through defined validation criteria. If no clinical information is provided and the result is lower than set levels, the result is given without clinical interpretations. Otherwise all genotyping/phenotyping and TDM results are electronically validated by a clinical pharmacologist or a clinical pharmacist. A clinical interpretation is given on the genotyping/phenotyping result or on the drug level, with a recommendation on the treatment also provided when necessary. The number of clinical interpretations for TDM results have increased from 1898 cases in 2007 to 7042 cases in 2015 (371% increase in 8 years), showing a need and wishes from clinicians, not only from our department but also from other hospitals and from private practice, to obtain such recommendations/interpretations. The UPPC is also strongly involved in teaching clinical psychopharmacology to medical doctors of the Department of Psychiatry, in particular with doctor's meetings from inpatient and outpatient wards to discuss and review drug treatments. During such meetings, when deemed useful, TDM and/or pharmacogenetic tests are recommended. The practical functioning of the UPPC within a university hospital will be presented, with clinical cases.