Exploring early intervention in psychosis (EIP) perspectives towards pharmacogenomics (PGx) implementation to support antipsychotic prescribing: a multi-method qualitative exploration

Introduction

Pharmacogenomics (PGx) is an emerging medicines optimization tool that may support efficacy and safety relating to antipsychotic prescribing. Despite growing drug-gene evidence linked to antipsychotic response, how PGx could be implemented within Early Intervention in Psychosis (EIP) services, including the views of staff, service users, and carers remains underexplored.

Methods

Semi-structured interviews with service users (n = 12), and online focus groups with EIP staff (n = 18), and carers (n = 3) across three National Health Service (NHS) EIP sites were analyzed using an integrative approach to reflexive thematic analysis.

Results

Five themes and seven sub-themes were synthesized to describe stakeholder perspectives on implementing PGx to support antipsychotic prescribing in EIP services. Participants characterized EIP as a complex care ecosystem and described varying levels of understanding about PGx. Findings highlighted key implementation considerations, including when PGx should be offered, communication strategies, concerns about its integration into EIP pathways, and preferences for embedding PGx within routine care.

Discussion

PGx was broadly perceived as an acceptable clinical intervention, analogous to established medicines-safety checks. However, implementation should prioritize shared decision-making, set realistic expectations about clinical utility, and be adequately resourced to avoid displacing other therapeutic approaches. This study complements existing drug-gene evidence by providing insights into clinical workflow integration, governance, and service design considerations specific to EIP contexts. As the evidence base for routine PGx use matures, its introduction in EIP services should be framed as a supportive, person-centered adjunct, and not a determinant of antipsychotic decision-making.