INTRODUCTION: Pharmacogenomic testing in psychiatry is an emerging area with potential clinical application of guiding medication choice and dosing. Interest has been fanned by commercial pharmacogenomic providers who have commonly marketed combinatorial panels that are direct-to-consumer. However, this has not been adopted widely due to a combination of barriers that include a varying evidence base, clinician and patient familiarity and acceptance, uncertainty about cost-effectiveness, and regulatory requirements. This review aims to examine recent updates in this field and provide a contextualised summary and recom-mendations for Asian populations in order to guide healthcare professionals in psychiatric practice. METHOD: A review of recent literature about current evidence and guidelines surrounding pharmacoge-nomics in psychiatric practice was carried out with particular attention paid to literature evaluating Asian populations. The Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework was applied. Consensus meetings comprising workgroup psychiatrists from the public and private sectors were held prior to arriving at the key recommendations. RESULTS: Pharmacogenomic testing should be mainly limited to drug-gene pairs with established clinical evidence, such as antidepressants and CYP2C19/ CYP2D6. Direct-to-consumer pharmacogenomic panels that assay multiple genes and analyse them via proprietary algorithms, are not presently recommended in Singapore's psychiatric setting due to inconclusive evidence on clinical outcomes. CONCLUSION Pharmacogenomic testing in psychiatry is not recommended as standard clinical practice. Exceptions may include concerns about drug concentrations or potential severe adverse drug reactions. Studies investigating newly identified drug-gene associations, and clinical effectiveness and cost-effectiveness of utilising pharmacogenomic testing in psychiatry is encouraged.
Humans ; Psychiatry/methods* ; Pharmacogenetics ; Cytochrome P-450 CYP2C19/genetics* ; Asian People/genetics* ; Pharmacogenomic Testing/methods* ; Antidepressive Agents/therapeutic use* ; Cytochrome P-450 CYP2D6/genetics* ; Practice Guidelines as Topic ; Singapore ; Mental Disorders/genetics* ; Psychotropic Drugs/therapeutic use*

Background: Existing techniques of predicting difficult laryngoscopy are inadequate requiring evaluation of Maxillopharyngeal Angle (MP-A) on lateral cervical radiograph described. Objectives: This study aimed to compare MP-A test with Modified Mallapati Test (MMT) in predicting their diagnostic values and Area Under Curve of Receiver Operating Characteristic Curve (AUCROCC) of both test. Methods: This is a double blinded interventional study of 93 patients. Each patient’s MMT score was assessed during preoperative assessment and subsequent MP-A test done by obtaining lateral cervical radiograph with the head in neutral position. Laryngeal view was assessed using Cormack-Lehane grade after induction of anesthesia, was used as reference standard to determine the diagnostic values of MMT and MP-A respectively. Results: The MP-Acompared to MMT in predicting difficult larngoscopy had higher sensitivity (77.78 vs 44.44) specificity (88.10 vs 67.86) and accuracy (87.10 vs 65.59) with higher Odd Ratio(26.12 vs 1.68). The AUCROCC was significantly higher in MP-A test 0.83(95%CI: 0.67, 0.99) (P = 0.001) vs MMT 0.56(95%CI: 0.36, 0.76) (P = 0.546) with LR+ of 6.53 vs 1.38. Conclusion: The Maxillopharyngeal Angle test was superior in predicting difficult laryngoscopy as compared to Modified Mallampati Test.difficult intubation