Historical Perspective and Clinical Implementation of Pharmacogenomics (PGx) Technology with Clinical Decision Support (CDS) in Child and Adolescent Psychiatry

Pharmacogenomics (PGx) uses the variation in a patient’s genetic profile to assist with medication choice, with the goal of shortening the trial-and-error process of prescribing in psychiatry. Over the past few decades, PGx technology has evolved greatly to identify various genetic polymorphisms in drug-metabolizing enzymes; however, clinical use and relevance of PGx in child and adolescent psychiatry (CAAP) remain limited. This narrative review explores the historical evolution of PGx, compares key technological advancements, and evaluates their clinical relevance to CAAP. We address current barriers to PGx implementation, including developmental differences in pharmacokinetics between adults and children, the lack of robust evidence of clinical efficacy in youth populations, and inconsistent guidelines causing clinician confusion. We also highlight the need for clinical decision support (CDS) tools and broader practical and ethical considerations before widespread uptake of PGx would be feasible.