1
|
Vest BM, Wray LO, Thase ME, Brady LA, Chapman SR, Oslin DW. Providers' Use of Pharmacogenetic Testing to Inform Antidepressant Prescribing: Results of Qualitative Interviews. Psychiatr Serv 2023; 74:1270-1276. [PMID: 37528698 DOI: 10.1176/appi.ps.20220537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Pharmacogenetic testing (PGx) for patients experiencing depression has been associated with modest improvements in symptoms. However, little is known about providers' use of PGx, including how and for whom providers use the test results in clinical decision making. In this article, results from qualitative interviews on the experience of providers participating in a pragmatic trial of PGx are described; implications of the providers' experiences are highlighted to inform future implementation of PGx. METHODS Interviews were conducted with providers participating in the trial (N=61) who treated veterans who had depression. Questions were informed by the Consolidated Framework for Implementation Research. A rapid analytic approach was used. RESULTS Two main themes were identified: perceptions regarding which patients would likely benefit from PGx and approaches to using the test results in prescribing. Providers generally expressed positive experiences with using PGx results. However, the providers varied in application of the test results to clinical decision making regarding medications, were uncertain about how much to rely on the results, and differed in perceptions about which patients would benefit from PGx. CONCLUSIONS To support future implementation, policies and procedures are needed, as well as mechanisms to support ongoing provider education on PGx.
Collapse
Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| | - Laura O Wray
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| | - Michael E Thase
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| | - Laura A Brady
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| | - Sara R Chapman
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| | - David W Oslin
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo (Vest, Wray, Brady); Center for Integrated Healthcare, U.S. Department of Veterans Affairs (VA) Western New York Healthcare System, Buffalo (Vest, Wray); Veterans Integrated Service Network (VISN) 4, Mental Illness, Research, Education and Clinical Center (MIRECC), Corporal Michael J. Crescenz VA Medical Center, Philadelphia (Thase, Oslin); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Thase, Oslin); VISN 4 MIRECC, VA Pittsburgh Healthcare System, Pittsburgh (Chapman)
| |
Collapse
|
2
|
Wade B, Pindale R, Camprodon J, Luccarelli J, Li S, Meisner R, Seiner S, Henry M. Individual Prediction of Optimal Treatment Allocation Between Electroconvulsive Therapy or Ketamine using the Personalized Advantage Index. RESEARCH SQUARE 2023:rs.3.rs-3682009. [PMID: 38077094 PMCID: PMC10705694 DOI: 10.21203/rs.3.rs-3682009/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Introduction Electroconvulsive therapy (ECT) and ketamine are two effective treatments for depression with similar efficacy; however, individual patient outcomes may be improved by models that predict optimal treatment assignment. Here, we adapt the Personalized Advantage Index (PAI) algorithm using machine learning to predict optimal treatment assignment between ECT and ketamine using medical record data from a large, naturalistic patient cohort. We hypothesized that patients who received a treatment predicted to be optimal would have significantly better outcomes following treatment compared to those who received a non-optimal treatment. Methods Data on 2526 ECT and 235 mixed IV ketamine and esketamine patients from McLean Hospital was aggregated. Depressive symptoms were measured using the Quick Inventory of Depressive Symptomatology (QIDS) before and during acute treatment. Patients were matched between treatments on pretreatment QIDS, age, inpatient status, and psychotic symptoms using a 1:1 ratio yielding a sample of 470 patients (n=235 per treatment). Random forest models were trained and predicted differential patientwise minimum QIDS scores achieved during acute treatment (min-QIDS) scores for ECT and ketamine using pretreatment patient measures. Analysis of Shapley Additive exPlanations (SHAP) values identified predictors of differential outcomes between treatments. Results Twenty-seven percent of patients with the largest PAI scores who received a treatment predicted optimal had significantly lower min-QIDS scores compared to those who received a non-optimal treatment (mean difference=1.6, t=2.38, q<0.05, Cohen's D=0.36). Analysis of SHAP values identified prescriptive pretreatment measures. Conclusions Patients assigned to a treatment predicted to be optimal had significantly better treatment outcomes. Our model identified pretreatment patient factors captured in medical records that can provide interpretable and actionable guidelines treatment selection.
Collapse
Affiliation(s)
- Benjamin Wade
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ryan Pindale
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joan Camprodon
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shuang Li
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Robert Meisner
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Stephen Seiner
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Michael Henry
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Lencz T, Moyett A, Argyelan M, Barber AD, Cholewa J, Birnbaum ML, Gallego JA, John M, Szeszko PR, Robinson DG, Malhotra AK. Frontal lobe fALFF measured from resting-state fMRI as a prognostic biomarker in first-episode psychosis. Neuropsychopharmacology 2022; 47:2245-2251. [PMID: 36198875 PMCID: PMC9630308 DOI: 10.1038/s41386-022-01470-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 11/09/2022]
Abstract
Clinical response to antipsychotic drug treatment is highly variable, yet prognostic biomarkers are lacking. The goal of the present study was to test whether the fractional amplitude of low-frequency fluctuations (fALFF), as measured from baseline resting-state fMRI data, can serve as a potential biomarker of treatment response to antipsychotics. Patients in the first episode of psychosis (n = 126) were enrolled in two prospective studies employing second-generation antipsychotics (risperidone or aripiprazole). Patients were scanned at the initiation of treatment on a 3T MRI scanner (Study 1, GE Signa HDx, n = 74; Study 2, Siemens Prisma, n = 52). Voxelwise fALFF derived from baseline resting-state fMRI scans served as the primary measure of interest, providing a hypothesis-free (as opposed to region-of-interest) search for regions of the brain that might be predictive of response. At baseline, patients who would later meet strict criteria for clinical response (defined as two consecutive ratings of much or very much improved on the CGI, as well as a rating of ≤3 on psychosis-related items of the BPRS-A) demonstrated significantly greater baseline fALFF in bilateral orbitofrontal cortex compared to non-responders. Thus, spontaneous activity in orbitofrontal cortex may serve as a prognostic biomarker of antipsychotic treatment.
Collapse
Affiliation(s)
- Todd Lencz
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11550, USA.
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, 11004, USA.
- Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA.
| | - Ashley Moyett
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, 11004, USA
| | - Miklos Argyelan
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11550, USA
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, 11004, USA
- Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Anita D Barber
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, 11004, USA
- Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - John Cholewa
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, 11004, USA
| | - Michael L Birnbaum
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11550, USA
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, 11004, USA
- Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Juan A Gallego
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11550, USA
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, 11004, USA
- Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Majnu John
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, 11004, USA
- Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
- Department of Mathematics, Hofstra University, Hempstead, NY, 11549, USA
| | - Philip R Szeszko
- James J. Peters VA Medical Center, Bronx, NY, 10468, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Delbert G Robinson
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11550, USA
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, 11004, USA
- Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| | - Anil K Malhotra
- Department of Psychiatry, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, 11550, USA
- Department of Psychiatry, Division of Research, The Zucker Hillside Hospital Division of Northwell Health, Glen Oaks, NY, 11004, USA
- Institute for Behavioral Science, The Feinstein Institutes for Medical Research, Manhasset, NY, 11030, USA
| |
Collapse
|
4
|
Lisoway AJ, Chen CC, Zai CC, Tiwari AK, Kennedy JL. Toward personalized medicine in schizophrenia: Genetics and epigenetics of antipsychotic treatment. Schizophr Res 2021; 232:112-124. [PMID: 34049235 DOI: 10.1016/j.schres.2021.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 12/21/2022]
Abstract
Schizophrenia is a complex psychiatric disorder where genetic, epigenetic, and environmental factors play a role in disease onset, course of illness, and treatment outcome. Pharmaco(epi)genetic research presents an important opportunity to improve patient care through prediction of medication side effects and response. In this narrative review, we discuss the current state of research and important progress of both genetic and epigenetic factors involved in antipsychotic response, over the past five years. The review is largely focused on the following frequently prescribed antipsychotics: olanzapine, risperidone, aripiprazole, and clozapine. Several consistent pharmacogenetic findings have emerged, in particular pharmacokinetic genes (primarily cytochrome P450 enzymes) and pharmacodynamic genes involving dopamine, serotonin, and glutamate neurotransmission. In addition to studies analysing DNA sequence variants, there are also several pharmacoepigenetic studies of antipsychotic response that have focused on the measurement of DNA methylation. Although pharmacoepigenetics is still in its infancy, consideration of both genetic and epigenetic factors contributing to antipsychotic response and side effects no doubt will be increasingly important in personalized medicine. We provide recommendations for next steps in research and clinical evaluation.
Collapse
Affiliation(s)
- Amanda J Lisoway
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Cheng C Chen
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada
| | - Clement C Zai
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Arun K Tiwari
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Canada
| | - James L Kennedy
- Molecular Brain Science Department, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada.
| |
Collapse
|
5
|
Carvalho Henriques B, Yang EH, Lapetina D, Carr MS, Yavorskyy V, Hague J, Aitchison KJ. How Can Drug Metabolism and Transporter Genetics Inform Psychotropic Prescribing? Front Genet 2020; 11:491895. [PMID: 33363564 PMCID: PMC7753050 DOI: 10.3389/fgene.2020.491895] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 09/25/2020] [Indexed: 12/11/2022] Open
Abstract
Many genetic variants in drug metabolizing enzymes and transporters have been shown to be relevant for treating psychiatric disorders. Associations are strong enough to feature on drug labels and for prescribing guidelines based on such data. A range of commercial tests are available; however, there is variability in included genetic variants, methodology, and interpretation. We herein provide relevant background for understanding clinical associations with specific variants, other factors that are relevant to consider when interpreting such data (such as age, gender, drug-drug interactions), and summarize the data relevant to clinical utility of pharmacogenetic testing in psychiatry and the available prescribing guidelines. We also highlight areas for future research focus in this field.
Collapse
Affiliation(s)
| | - Esther H. Yang
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Diego Lapetina
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Michael S. Carr
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Vasyl Yavorskyy
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Joshua Hague
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
| | - Katherine J. Aitchison
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Department of Medical Genetics, University of Alberta, Edmonton, AB, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
6
|
Vest BM, Wray LO, Brady LA, Thase ME, Beehler GP, Chapman SR, Hull LE, Oslin DW. Primary care and mental health providers' perceptions of implementation of pharmacogenetics testing for depression prescribing. BMC Psychiatry 2020; 20:518. [PMID: 33115428 PMCID: PMC7594429 DOI: 10.1186/s12888-020-02919-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/15/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pharmacogenetic testing (PGx) has the potential to improve the quality of psychiatric prescribing by considering patients' genetic profile. However, there is limited scientific evidence supporting its efficacy or guiding its implementation. The Precision Medicine in Mental Health (PRIME) Care study is a pragmatic randomized controlled trial evaluating the effectiveness of a specific commercially-available pharmacogenetic (PGx) test to inform antidepressant prescribing at 22 sites across the U.S. Simultaneous implementation science methods using the Consolidated Framework for Implementation Research (CFIR) are integrated throughout the trial to identify contextual factors likely to be important in future implementation of PGx. The goal of this study was to understand providers' perceptions of PGx for antidepressant prescribing and implications for future implementation. METHODS Qualitative focus groups (n = 10) were conducted at the beginning of the trial with Primary Care and Mental Health providers (n = 31) from six PRIME Care sites. Focus groups were audio-recorded and transcribed and data were analyzed using rapid analytic procedures organized by CFIR domains. RESULTS Analysis revealed themes in the CFIR Intervention Characteristics domain constructs of Evidence, Relative Advantage, Adaptability, Trialability, Complexity, and Design that are important for understanding providers' perceptions of PGx testing. Results indicate: 1) providers had limited experience and knowledge of PGx testing and its evidence base, particularly for psychiatric medications; 2) providers were hopeful that PGx could increase their precision in depression prescribing and improve patient engagement, but were uncertain about how results would influence treatment; 3) providers were concerned about potential misinterpretation of PGx results and how to incorporate testing into their workflow; 4) primary care providers were less familiar and comfortable with application of PGx testing to antidepressant prescribing than psychiatric providers. CONCLUSIONS Provider perceptions may serve as facilitators or barriers to implementation of PGx for psychiatric prescribing. Incorporating implementation science into the conduct of the RCT adds value by uncovering factors to be addressed in preparing for future implementation, should the practice prove effective. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03170362 ; Registered 31 May 2017.
Collapse
Affiliation(s)
- Bonnie M. Vest
- grid.273335.30000 0004 1936 9887Department of Family Medicine, State University of New York- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY USA ,grid.416805.e0000 0004 0420 1352VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY USA
| | - Laura O. Wray
- grid.273335.30000 0004 1936 9887Department of Family Medicine, State University of New York- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY USA ,grid.416805.e0000 0004 0420 1352VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY USA
| | - Laura A. Brady
- grid.273335.30000 0004 1936 9887Department of Family Medicine, State University of New York- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY USA ,grid.416805.e0000 0004 0420 1352VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY USA
| | - Michael E. Thase
- grid.410355.60000 0004 0420 350XVISN 4 Mental Illness, Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA USA ,grid.25879.310000 0004 1936 8972Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Gregory P. Beehler
- grid.416805.e0000 0004 0420 1352VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, NY USA ,grid.273335.30000 0004 1936 9887State University of New York- University at Buffalo, School of Public Health and Health Professions, Buffalo, NY USA
| | - Sara R. Chapman
- grid.413935.90000 0004 0420 3665VISN 4 Mental Illness, Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA USA
| | - Leland E. Hull
- grid.32224.350000 0004 0386 9924Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - David W. Oslin
- grid.410355.60000 0004 0420 350XVISN 4 Mental Illness, Research, Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA USA ,grid.25879.310000 0004 1936 8972Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| |
Collapse
|
7
|
King CD, Yip AG, Cao YA, Rodriguez-Villa F, Krause DS, Dowd D, Ressler KJ. Open-label pilot study of psychiatric pharmacogenetic testing in an adult psychiatric inpatient population. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.pmip.2020.100060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
8
|
Association between functional polymorphisms in serotonin transporter gene (SLC6A4) and escitalopram treatment response in depressive patients in a South Indian population. Eur J Clin Pharmacol 2020; 76:807-814. [DOI: 10.1007/s00228-020-02866-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 03/26/2020] [Indexed: 12/16/2022]
|
9
|
Yoshida K, Müller DJ. Pharmacogenetics of Antipsychotic Drug Treatment: Update and Clinical Implications. MOLECULAR NEUROPSYCHIATRY 2020; 5:1-26. [PMID: 32399466 PMCID: PMC7206586 DOI: 10.1159/000492332] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/20/2018] [Indexed: 12/24/2022]
Abstract
Numerous genetic variants have been shown to be associated with antipsychotic response and adverse effects of schizophrenia treatment. However, the clinical application of these findings is limited. The aim of this narrative review is to summarize the most recent publications and recommendations related to the genetics of antipsychotic treatment and shed light on the clinical utility of pharmacogenetics/pharmacogenomics (PGx). We reviewed the literature on PGx studies with antipsychotic drugs (i.e., antipsychotic response and adverse effects) and commonly used commercial PGx tools for clinical practice. Publications and reviews were included with emphasis on articles published between January 2015 and April 2018. We found 44 studies focusing on antipsychotic response and 45 studies on adverse effects (e.g., antipsychotic-induced weight gain, movement disorders, hormonal abnormality, and clozapine-induced agranulocytosis/granulocytopenia), albeit with mixed results. Overall, several gene variants related to antipsychotic response and adverse effects in the treatment of patients with schizophrenia have been reported, and several commercial pharmacogenomic tests have become available. However, further well-designed investigations and replication studies in large and well-characterized samples are needed to facilitate the application of PGx findings to clinical practice.
Collapse
Affiliation(s)
- Kazunari Yoshida
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Daniel J. Müller
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Guan F, Zhang T, Han W, Zhu L, Ni T, Lin H, Liu D, Chen G, Xiao J, Li T. Relationship of SNAP25 variants with schizophrenia and antipsychotic-induced weight change in large-scale schizophrenia patients. Schizophr Res 2020; 215:250-255. [PMID: 31653583 DOI: 10.1016/j.schres.2019.09.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/19/2019] [Accepted: 09/23/2019] [Indexed: 01/16/2023]
Abstract
The SNAP25 gene is involved in the development of antipsychotic-induced weight gain (AIWG) or metabolic syndrome during antipsychotics use in Americans and Europeans, but its role in Asians remains unknown. To identify common variants in SNAP25 associated with schizophrenia and evaluate their effects on AIWG and antipsychotic responses in Han Chinese individuals with schizophrenia, we conducted a two-stage case-control study of 3,243 patients and 6,154 healthy controls. 2128 inpatients in the replication stage have received conventional treatment with an antipsychotic monotherapy (Haloperidol, Olanzapine or Risperidone) for 10 weeks at least. Weight change, antipsychotic responses and metabolic indices change were assessed during treatments. Three SNPs were significantly associated with schizophrenia in samples (rs6039769, P = 6.64 × 10-7; rs3787283, P = 0.004283; rs3746544, P = 2.51 × 10-6). Of these, rs6039769 is a novel schizophrenia-associated SNP and is uncorrelated with the other two variants, which have previously been associated with schizophrenia in European-ancestry samples. Rs6039769 was significantly associated with AIWG (P < 0.001), but not with antipsychotic responses or metabolic indices. Another two SNPs were not associated with AIWG or antipsychotic responses or metabolic indices. Overall, there were significant differences in antipsychotic responses and metabolic indices among the three treatment groups. Our findings suggest that SNAP25 gene may contribute to the susceptibility of AIWG and even metabolic disturbances. A prior identification of high-risk of patients with rs6039769 would contribute to a better precision of the pharmacological treatment.
Collapse
Affiliation(s)
- Fanglin Guan
- Department of Forensic Psychiatry, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China; Key Laboratory of National Ministry of Health for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Tianxiao Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Wei Han
- Department of Forensic Psychiatry, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China; Key Laboratory of National Ministry of Health for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Li Zhu
- Department of Forensic Psychiatry, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China; Key Laboratory of National Ministry of Health for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Tong Ni
- Department of Forensic Psychiatry, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China; Key Laboratory of National Ministry of Health for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Huali Lin
- Xi'an Mental Health Center, 15 Yanyin Road, Xi'an, Shaanxi, 710086, China
| | - Dan Liu
- Department of Forensic Psychiatry, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China; Key Laboratory of National Ministry of Health for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Gang Chen
- Key Laboratory of National Ministry of Health for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China; Department of Forensic Pathology, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Jing Xiao
- Key Laboratory of National Ministry of Health for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China; Department of Forensic Pathology, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China
| | - Tao Li
- Key Laboratory of National Ministry of Health for Forensic Sciences, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China; Department of Forensic Pathology, School of Medicine & Forensics, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, Shaanxi, 710061, China.
| |
Collapse
|
11
|
Hu Y, Zhao T, Zang T, Zhang Y, Cheng L. Identification of Alzheimer's Disease-Related Genes Based on Data Integration Method. Front Genet 2019; 9:703. [PMID: 30740125 PMCID: PMC6355707 DOI: 10.3389/fgene.2018.00703] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/14/2018] [Indexed: 01/18/2023] Open
Abstract
Alzheimer disease (AD) is the fourth major cause of death in the elderly following cancer, heart disease and cerebrovascular disease. Finding candidate causal genes can help in the design of Gene targeted drugs and effectively reduce the risk of the disease. Complex diseases such as AD are usually caused by multiple genes. The Genome-wide association study (GWAS), has identified the potential genetic variants for most diseases. However, because of linkage disequilibrium (LD), it is difficult to identify the causative mutations that directly cause diseases. In this study, we combined expression quantitative trait locus (eQTL) studies with the GWAS, to comprehensively define the genes that cause Alzheimer disease. The method used was the Summary Mendelian randomization (SMR), which is a novel method to integrate summarized data. Two GWAS studies and five eQTL studies were referenced in this paper. We found several candidate SNPs that have a strong relationship with AD. Most of these SNPs overlap in different data sets, providing relatively strong reliability. We also explain the function of the novel AD-related genes we have discovered.
Collapse
Affiliation(s)
- Yang Hu
- Department of Computer Science and Technology, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Tianyi Zhao
- Department of Computer Science and Technology, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Tianyi Zang
- Department of Computer Science and Technology, School of Life Science and Technology, Harbin Institute of Technology, Harbin, China
| | - Ying Zhang
- Department of Rehabilitation, Heilongjiang Province Land Reclamation Headquarters General Hospital, Harbin, China
| | - Liang Cheng
- Department of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China
| |
Collapse
|
12
|
Zhang JP, Robinson D, Yu J, Gallego J, Wolfgang Fleischhacker W, Kahn RS, Crespo-Facorro B, Vazquez-Bourgon J, Kane JM, Malhotra AK, Lencz T. Schizophrenia Polygenic Risk Score as a Predictor of Antipsychotic Efficacy in First-Episode Psychosis. Am J Psychiatry 2019; 176:21-28. [PMID: 30392411 PMCID: PMC6461047 DOI: 10.1176/appi.ajp.2018.17121363] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Pharmacogenomic studies of antipsychotics have typically examined effects of individual polymorphisms. By contrast, polygenic risk scores (PRSs) derived from genome-wide association studies (GWAS) can quantify the influence of thousands of common alleles of small effect in a single measure. The authors examined whether PRSs for schizophrenia were predictive of antipsychotic efficacy in four independent cohorts of patients with first-episode psychosis (total N=510). METHOD All study subjects received initial treatment with antipsychotic medication for first-episode psychosis, and all were genotyped on standard single-nucleotide polymorphism (SNP) arrays imputed to the 1000 Genomes Project reference panel. PRS was computed based on the results of the large-scale schizophrenia GWAS reported by the Psychiatric Genomics Consortium. Symptoms were measured by using total symptom rating scales at baseline and at week 12 or at the last follow-up visit before dropout. RESULTS In the discovery cohort, higher PRS significantly predicted higher symptom scores at the 12-week follow-up (controlling for baseline symptoms, sex, age, and ethnicity). The PRS threshold set at a p value <0.01 gave the strongest result in the discovery cohort and was used to replicate the findings in the other three cohorts. Higher PRS significantly predicted greater posttreatment symptoms in the combined replication analysis and was individually significant in two of the three replication cohorts. Across the four cohorts, PRS was significantly predictive of adjusted 12-week symptom scores (pooled partial r=0.18; 3.24% of variance explained). Patients with low PRS were more likely to be treatment responders than patients with high PRS (odds ratio=1.91 in the two Caucasian samples). CONCLUSIONS Patients with higher PRS for schizophrenia tended to have less improvement with antipsychotic drug treatment. PRS burden may have potential utility as a prognostic biomarker.
Collapse
Affiliation(s)
- Jian-Ping Zhang
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
| | - Delbert Robinson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
| | - Jin Yu
- The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA
| | - Juan Gallego
- Weill Cornell Medical College, NewYork-Presbyterian/Westchester Division, White Plains, NY, USA
| | | | - Rene S. Kahn
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benedicto Crespo-Facorro
- Department of Medicine and Psychiatry, University of Cantabria, CIBERSAM, IDIVAL, University Hospital Marqués de Valdecilla, Santander, Spain
| | - Javier Vazquez-Bourgon
- Department of Medicine and Psychiatry, University of Cantabria, CIBERSAM, IDIVAL, University Hospital Marqués de Valdecilla, Santander, Spain
| | - John M. Kane
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
| | - Anil K. Malhotra
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
| | - Todd Lencz
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA,The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, NY, USA,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, NY, USA
| |
Collapse
|
13
|
Miura I, Kunii Y, Hino M, Hoshino H, Matsumoto J, Kanno-Nozaki K, Horikoshi S, Kaneko H, Bundo M, Iwamoto K, Yabe H. DNA methylation of ANKK1 and response to aripiprazole in patients with acute schizophrenia: A preliminary study. J Psychiatr Res 2018; 100:84-87. [PMID: 29499474 DOI: 10.1016/j.jpsychires.2018.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/17/2018] [Accepted: 02/22/2018] [Indexed: 11/19/2022]
Abstract
Epigenetic modification including DNA methylation may affect pathophysiology and the response to antipsychotic drugs in patients with schizophrenia. The objective of the present study was to investigate the effect of the DNA methylation of ANKK1 (ankyrin repeat and kinase domain containing 1) on the response to aripiprazole and plasma levels of monoamine metabolites in antipsychotic-free acute schizophrenia patients. The subjects were 34 Japanese patients with schizophrenia who had been treated with aripiprazole for 6 weeks. Comprehensive DNA methylation of ANKK1 was determined using a next-generation sequencer. DNA methylation levels at CpG site 387 of ANKK1 were higher in responders to treatment with aripiprazole and correlated with the changes in Positive and Negative Syndrome Scale scores, although the associations did not remain significant after Bonferroni correction. In responders, methylation at all CpG sites was significantly correlated with plasma levels of homovanillic acid (r = 0.587, p = 0.035) and 3-methoxy-4hydroxyphenylglycol (r = 0.684, p = 0.010) at baseline. Despite our non-significant results after multiple correction, our preliminary findings suggest that methylation levels at CpG site 387 of ANKK1 may be associated with treatment response to aripiprazole. Furthermore, methylation of ANKK1 may affect dopaminergic neural transmission in the treatment of schizophrenia, and may influence treatment response. Caution is needed in interpreting these findings because of the small sample size, and further studies are needed to confirm and expand our preliminary results.
Collapse
Affiliation(s)
- Itaru Miura
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan.
| | - Yasuto Kunii
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mizuki Hino
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroshi Hoshino
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Junya Matsumoto
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Keiko Kanno-Nozaki
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Sho Horikoshi
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Haruka Kaneko
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Miki Bundo
- Department of Molecular Brain Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kazuya Iwamoto
- Department of Molecular Brain Science, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hirooki Yabe
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
14
|
Soleimani R, Salehi Z, Soltanipour S, Hasandokht T, Jalali MM. SLC6A3 polymorphism and response to methylphenidate in children with ADHD: A systematic review and meta-analysis. Am J Med Genet B Neuropsychiatr Genet 2018; 177:287-300. [PMID: 29171685 DOI: 10.1002/ajmg.b.32613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/13/2017] [Indexed: 01/29/2023]
Abstract
Methylphenidate (MPH) is the most commonly used treatment for attention-deficit hyperactivity disorder (ADHD) in children. However, the response to MPH is not similar in all patients. This meta-analysis investigated the potential role of SLC6A3 polymorphisms in response to MPH in children with ADHD. Clinical trials or naturalistic studies were selected from electronic databases. A meta-analysis was conducted using a random-effects model. Cohen's d effect size and 95% confidence intervals (CIs) were determined. Sensitivity analysis and meta-regression were performed. Q-statistic and Egger's tests were conducted to evaluate heterogeneity and publication bias, respectively. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Sixteen studies with follow-up periods of 1-28 weeks were eligible. The mean treatment acceptability of MPH was 97.2%. In contrast to clinical trials, the meta-analysis of naturalistic studies indicated that children without 10/10 repeat carriers had better response to MPH (Cohen's d: -0.09 and 0.44, respectively). The 9/9 repeat polymorphism had no effect on the response rate (Cohen's d: -0.43). In the meta-regression, a significant association was observed between baseline severity of ADHD, MPH dosage, and combined type of ADHD in some genetic models. Sensitivity analysis indicated the robustness of our findings. No publication bias was observed in our meta-analysis. The GRADE evaluations revealed very low levels of confidence for each outcome of response to MPH. The results of clinical trials and naturalistic studies regarding the effect size between different polymorphisms of SLC6A3 were contradictory. Therefore, further research is recommended.
Collapse
Affiliation(s)
- Robabeh Soleimani
- Psychiatry, Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Zivar Salehi
- Molecular Genetics, Department of Biology, University of Guilan, Rasht, Guilan, Iran
| | - Soheil Soltanipour
- Public Health and Preventive Medicine, Medical Faculty, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Tolou Hasandokht
- Public Health and Preventive Medicine, Medical Faculty, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| | - Mir Mohammad Jalali
- Otolaryngology, RhinoSinus diseases Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Guilan, Iran
| |
Collapse
|
15
|
New Targets for Schizophrenia Treatment beyond the Dopamine Hypothesis. Int J Mol Sci 2017; 18:ijms18081689. [PMID: 28771182 PMCID: PMC5578079 DOI: 10.3390/ijms18081689] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 07/30/2017] [Accepted: 08/01/2017] [Indexed: 12/14/2022] Open
Abstract
Schizophrenia has been primarily associated with dopamine dysfunction, and treatments have been developed that target the dopamine pathway in the central nervous system. However, accumulating evidence has shown that the core pathophysiology of schizophrenia might involve dysfunction in dopaminergic, glutamatergic, serotonergic, and gamma-aminobutyric acid (GABA) signaling, which may lead to aberrant functioning of interneurons that manifest as cognitive, behavioral, and social dysfunction through altered functioning of a broad range of macro- and microcircuits. The interactions between neurotransmitters can be modeled as nodes and edges by using graph theory, and oxidative balance, immune, and glutamatergic systems may represent multiple nodes interlocking at a central hub; imbalance within any of these nodes might affect the entire system. Therefore, this review attempts to address novel treatment targets beyond the dopamine hypothesis, including glutamate, serotonin, acetylcholine, GABA, and inflammatory cytokines. Furthermore, we outline that these treatment targets can be possibly integrated with novel treatment strategies aimed at different symptoms or phases of the illness. We anticipate that reversing anomalous activity in these novel treatment targets or combinations between these strategies might be beneficial in the treatment of schizophrenia.
Collapse
|
16
|
Muzyk AJ, Gagliardi JP, Rakesh G, Jiroutek MR, Radhakrishnan R, Pae CU, Masand PS, Szabo ST. Development of a Diverse Learning Experience for Diverse Psychiatry Resident Needs: A Four-Year Biological Psychiatry Curriculum Incorporating Principles of Neurobiology, Psychopharmacology, and Evidence-Based Practice. Psychiatry Investig 2017; 14:289-297. [PMID: 28539947 PMCID: PMC5440431 DOI: 10.4306/pi.2017.14.3.289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/15/2016] [Accepted: 06/03/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE A clinically relevant approach to patient care grounded in neurobiological constructs and evidence based practice which emphasizes a relevant psychopharmacology is needed to optimally train psychiatry residents. METHODS We implemented a biological psychiatry course that now incorporates neurobiology, psychopharmacology, and evidence-based practice in conjunction with a Research Domain Criteria (RDoC) perspective. A survey launched prior to course implementation and following each class session, served as the outcome metric of residents' attitudes toward the new curriculum and followed a baseline attitudinal survey designed to evaluate the program. RESULTS Greater than 90% of the psychiatry residents at Duke University who took the attitudinal survey agreed or strongly agreed with needing a course that helped them develop an understanding of neurobiology, psychopharmacology, and evidence-based practice concepts. Most residents also indicated a less than adequate understanding of the neurobiology and psychopharmacology of psychiatric disorders prior to sessions. CONCLUSION Our biological psychiatry curriculum was associated with enthusiasm among residents regarding the incorporation of neurobiology, psychopharmacology, and evidence-based practice into course topics and discussions. A biological psychiatry curriculum with integrated neurobiology and psychopharmacology built on an evidence base approach is possible, well-received, and needed in training of future psychiatrists.
Collapse
Affiliation(s)
- Andrew J Muzyk
- Department of Pharmacy Practice, Campbell University School of Pharmacy and Health Sciences, Buies Creek, NC, USA
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
| | - Jane P Gagliardi
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
- Department of Medicine, Duke University, Durham, NC, USA
| | - Gopalkumar Rakesh
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
| | - Michael R Jiroutek
- Department of Clinical Research, Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
| | | | - Chi-Un Pae
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
- Department of Psychiatry, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Prakash S Masand
- Academic Medicine Education Institute, Duke-NUS Medical School, Singapore
- Global Medical Education, New York, NY, USA
| | - Steven T Szabo
- Department of Psychiatry & Behavioral Sciences, Duke University, Durham, NC, USA
- Mental Health Service Line, Veterans Affairs Medical Center, Durham, NC, USA
| |
Collapse
|
17
|
Dubovsky SL. The Limitations of Genetic Testing in Psychiatry. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:129-35. [PMID: 27043036 DOI: 10.1159/000443512] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/20/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Steven L Dubovsky
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, N.Y., and Departments of Psychiatry and Medicine, University of Colorado, Denver, Colo., USA
| |
Collapse
|
18
|
Hodgins S, Klein S. New Clinically Relevant Findings about Violence by People with Schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:86-93. [PMID: 27605579 PMCID: PMC5298520 DOI: 10.1177/0706743716648300] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To review findings with clinical relevance that add to knowledge about antisocial and aggressive behaviour among persons with schizophrenia. METHOD Nonsystematic literature review. RESULTS Recent evidence shows that individuals who develop schizophrenia present cognitive deficits, psychotic-like experiences, and internalizing and externalizing problems from childhood onwards. Many of their relatives present not only schizophrenia-related disorders but also antisocial behaviour. While the increased risk of aggressive behaviour among persons with schizophrenia has been robustly established, recent findings show that by first contact with clinical services for psychosis, most people with schizophrenia who will engage in aggressive behaviour may be identified. At first episode, 2 distinct types are distinguishable: those who present a history of antisocial and aggressive behaviour since childhood and those who began engaging in aggressive behaviour as illness onsets. Antipsychotic medications and other treatments shown to be effective for schizophrenia are needed by both types of patients. Additionally, those with a history of antisocial and aggressive behaviour since childhood require cognitive-behavioural programs aimed at reducing these behaviours and promoting prosocial behaviour. Reducing physical victimisation and cannabis use will likely reduce aggressive behaviour. Evidence suggests that threats to hurt others often precede assaults. CONCLUSIONS At first contact with services, patients with schizophrenia who have engaged in aggressive behaviour should be identified and treated for schizophrenia and for aggression. Research is needed to identify interactions between genotypes and environmental factors, from conception onwards, that promote and that protect against the development of aggressive behaviour among persons with schizophrenia.
Collapse
Affiliation(s)
- Sheilagh Hodgins
- 1 Département de Psychiatrie, Institut Universitaire de Santé Mentale de Montréal, Université de Montréal, Montreal, Quebec.,2 Karolinska Institutet, Solna, Sweden
| | - Sanja Klein
- 3 Department of Psychology, University of Giessen, Gießen, Germany.,4 Vitos Klinik für forensische Psychiatrie Haina, Haina, Germany
| |
Collapse
|
19
|
Abstract
BACKGROUND Personalized medicine is a model in which a patient's unique clinical, genetic, and environmental characteristics are the basis for treatment and prevention. Aim, method, and results: This review aims to describe the current tools, phenomenological features, clinical risk factors, and biomarkers used to provide personalized medicine. Furthermore, this study describes the target areas in which they can be applied including diagnostics, treatment selection and response, assessment of risk of side-effects, and prevention. DISCUSSION AND CONCLUSION Personalized medicine in psychiatry is challenged by the current taxonomy, where the diagnostic categories are broad and great biological heterogeneity exists within each category. There is, thus, a gap between the current advanced research prospects and clinical practice, and the current taxonomy is, thus, a poor basis for biological research. The discussion proposes possible solutions to narrow this gap and to move psychiatric research forward towards personalized medicine.
Collapse
Affiliation(s)
| | - Maj Vinberg
- b Psychiatric Center Copenhagen , Copenhagen University , Copenhagen , Denmark
| | - Lars Vedel Kessing
- b Psychiatric Center Copenhagen , Copenhagen University , Copenhagen , Denmark
| | - Roger S McIntyre
- c Mood Disorders Psychopharmacology Unit , University Health Network , Toronto , ON , Canada
| |
Collapse
|
20
|
Lally J, Gaughran F, Timms P, Curran SR. Treatment-resistant schizophrenia: current insights on the pharmacogenomics of antipsychotics. Pharmgenomics Pers Med 2016; 9:117-129. [PMID: 27853387 PMCID: PMC5106233 DOI: 10.2147/pgpm.s115741] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Up to 30% of people with schizophrenia do not respond to two (or more) trials of dopaminergic antipsychotics. They are said to have treatment-resistant schizophrenia (TRS). Clozapine is still the only effective treatment for TRS, although it is underused in clinical practice. Initial use is delayed, it can be hard for patients to tolerate, and clinicians can be uncertain as to when to use it. What if, at the start of treatment, we could identify those patients likely to respond to clozapine - and those likely to suffer adverse effects? It is likely that clinicians would feel less inhibited about using it, allowing clozapine to be used earlier and more appropriately. Genetic testing holds out the tantalizing possibility of being able to do just this, and hence the vital importance of pharmacogenomic studies. These can potentially identify genetic markers for both tolerance of and vulnerability to clozapine. We aim to summarize progress so far, possible clinical applications, limitations to the evidence, and problems in applying these findings to the management of TRS. Pharmacogenomic studies of clozapine response and tolerability have produced conflicting results. These are due, at least in part, to significant differences in the patient groups studied. The use of clinical pharmacogenomic testing - to personalize clozapine treatment and identify patients at high risk of treatment failure or of adverse events - has moved closer over the last 20 years. However, to develop such testing that could be used clinically will require larger, multicenter, prospective studies.
Collapse
Affiliation(s)
- John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
- National Psychosis Service
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- National Psychosis Service
| | - Philip Timms
- START Team, South London and Maudsley NHS Foundation Trust
- King’s College London
| | - Sarah R Curran
- King’s College London
- South West London and St George’s Mental Health NHS Foundation Trust
- St George’s University of London, London, UK
| |
Collapse
|
21
|
Zhang JP, Lencz T, Zhang RX, Nitta M, Maayan L, John M, Robinson DG, Fleischhacker WW, Kahn RS, Ophoff RA, Kane JM, Malhotra AK, Correll CU. Pharmacogenetic Associations of Antipsychotic Drug-Related Weight Gain: A Systematic Review and Meta-analysis. Schizophr Bull 2016; 42:1418-1437. [PMID: 27217270 PMCID: PMC5049532 DOI: 10.1093/schbul/sbw058] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although weight gain is a serious but variable adverse effect of antipsychotics that has genetic underpinnings, a comprehensive meta-analysis of pharmacogenetics of antipsychotic-related weight gain is missing. In this review, random effects meta-analyses were conducted for dominant and recessive models on associations of specific single nucleotide polymorphisms (SNP) with prospectively assessed antipsychotic-related weight or body mass index (BMI) changes (primary outcome), or categorical increases in weight or BMI (≥7%; secondary outcome). Published studies, identified via systematic database search (last search: December 31, 2014), plus 3 additional cohorts, including 222 antipsychotic-naïve youth, and 81 and 141 first-episode schizophrenia adults, each with patient-level data at 3 or 4 months treatment, were meta-analyzed. Altogether, 72 articles reporting on 46 non-duplicated samples (n = 6700, mean follow-up = 25.1wk) with 38 SNPs from 20 genes/genomic regions were meta-analyzed (for each meta-analysis, studies = 2-20, n = 81-2082). Eleven SNPs from 8 genes were significantly associated with weight or BMI change, and 4 SNPs from 2 genes were significantly associated with categorical weight or BMI increase. Combined, 13 SNPs from 9 genes (Adrenoceptor Alpha-2A [ADRA2A], Adrenoceptor Beta 3 [ADRB3], Brain-Derived Neurotrophic Factor [BDNF], Dopamine Receptor D2 [DRD2], Guanine Nucleotide Binding Protein [GNB3], 5-Hydroxytryptamine (Serotonin) Receptor 2C [HTR2C], Insulin-induced gene 2 [INSIG2], Melanocortin-4 Receptor [MC4R], and Synaptosomal-associated protein, 25kDa [SNAP25]) were significantly associated with antipsychotic-related weight gain (P-values < .05-.001). SNPs in ADRA2A, DRD2, HTR2C, and MC4R had the largest effect sizes (Hedges' g's = 0.30-0.80, ORs = 1.47-1.96). Less prior antipsychotic exposure (pediatric or first episode patients) and short follow-up (1-2 mo) were associated with larger effect sizes. Individual antipsychotics did not significantly moderate effect sizes. In conclusion, antipsychotic-related weight gain is polygenic and associated with specific genetic variants, especially in genes coding for antipsychotic pharmacodynamic targets.
Collapse
Affiliation(s)
- Jian-Ping Zhang
- *To whom correspondence should be addressed; Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, 75-59 263rd Street, Glen Oaks, NY 11020, US; tel: 718-470-8471, fax: 718-470-1905, e-mail:
| | | | - Ryan X. Zhang
- Department of Psychology and Neuroscience, Duke University, Durham, NY
| | - Masahiro Nitta
- Drug Development Division, Sumitomo Dainippon Pharma Co. Ltd, Tokyo, Japan
| | - Lawrence Maayan
- Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Majnu John
- Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY;,Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Manhasset, NY;,Department of Mathematics, Hofstra University, Hempstead, NY
| | | | | | - Rene S. Kahn
- Department of Psychiatry, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Roel A. Ophoff
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - John M. Kane
- Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY
| | | | - Christoph U. Correll
- Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY,Both authors contributed equally to the article
| |
Collapse
|
22
|
Chen CK, Lee CS, Chen HY, Wu LSH, Chang JC, Liu CY, Cheng ATA. GADL1 variant and medication adherence in predicting response to lithium maintenance treatment in bipolar I disorder. BJPsych Open 2016; 2:301-306. [PMID: 27703793 PMCID: PMC5015003 DOI: 10.1192/bjpo.bp.116.002881] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/19/2016] [Accepted: 08/08/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Genetic variants and medication adherence have been identified to be the main factors contributing to lithium treatment response in bipolar disorders. AIMS To simultaneously examine effects of variant glutamate decarboxylase-like protein 1 (GADL1) and medication adherence on response to lithium maintenance treatment in Han Chinese patients with bipolar I (BPI) disorder. METHOD Frequencies of manic and depressive episodes between carriers and non-carriers of the effective GADL1 rs17026688 T allele during the cumulative periods of off-lithium, poor adherence to lithium treatment and good adherence to lithium treatment were compared in Han Chinese patients with BPI disorder (n=215). RESULTS GADL1 rs17026688 T carriers had significantly lower frequencies of recurrent affective episodes than non-T carriers during the cumulative period of good adherence, but not during those of poor adherence. CONCLUSIONS GADL1 rs17026688 and medication adherence jointly predict response to lithium maintenance treatment in Han Chinese BPI patients. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
Collapse
Affiliation(s)
- Chih-Ken Chen
- , MD, PhD, Chang Gung University School of Medicine, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chau-Shoun Lee
- , MD, PhD, Department of Medicine, Mackay Medical College, New Taipei City, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsuan-Yu Chen
- , PhD, Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | | | - Jung-Chen Chang
- , PhD, School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Yih Liu
- , MD, Department of Psychiatry, Chang Gung Medical Center at Linkou, Chang Gung University, Taoyuan, Taiwan; Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Andrew Tai-Ann Cheng
- , MD, PhD, DSc (London), FRCPsych, Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| |
Collapse
|
23
|
Sutherland A, Power RJ, Rahman P, O'Rielly DD. Pharmacogenetics and pharmacogenomics in psoriasis treatment: current challenges and future prospects. Expert Opin Drug Metab Toxicol 2016; 12:923-35. [PMID: 27266955 DOI: 10.1080/17425255.2016.1194394] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Topical, systemic, oral disease modifying, and biologic agents are part of the armamentarium to manage psoriatic disease. The choice of therapy depends upon disease severity, relevant co-morbidities and patient preference. There is great variability in patient response with these agents, and there is still no clear method of selecting the preferred therapeutic agent for efficacy or lack of adverse events. AREAS COVERED This article will review the pharmacogenetic and pharmacogenomic targets that are currently known with respect to psoriasis vulgaris, and the most frequent co-morbidity of psoriasis, psoriatic arthritis. EXPERT OPINION Presently, no clinically actionable biomarker exists for any therapeutic agent used to treat psoriasis or psoriatic arthritis. The lack of validated outcome measures and conflicting results of open-label studies conducted may be attributed to a multitude of issues that confound discovery. Consequently, studies have been underpowered to identify genes or genetic variants worth translating to clinical practice. In order to achieve a pharmacogenetic/pharmacogenomic signature, improvements in study design of future investigations are required, including carefully designed prospective studies. It is imperative to combine known clinical, serological, and molecular markers with consistent outcomes and an adequate health economic evaluation before they can be adopted widely in clinical practice.
Collapse
Affiliation(s)
- Alison Sutherland
- a Faculty of Medicine , Memorial University of Newfoundland , St. John's , NL , Canada
| | - Rebecca J Power
- a Faculty of Medicine , Memorial University of Newfoundland , St. John's , NL , Canada
| | - Proton Rahman
- a Faculty of Medicine , Memorial University of Newfoundland , St. John's , NL , Canada
| | - Darren D O'Rielly
- a Faculty of Medicine , Memorial University of Newfoundland , St. John's , NL , Canada
| |
Collapse
|
24
|
Burke E, Love R, Jones P, Fife T. Pharmacogenetic Testing: Application in Mental Health Prescribing. J Am Psychiatr Nurses Assoc 2016; 22:185-191. [PMID: 27009929 DOI: 10.1177/1078390316641488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite extensive scholastic and professional training, medication management in psychiatry is often relegated to trial-and-error prescribing. Pharmacogenetic testing (PGT) may expedite identification of medications with maximal efficacy and minimal side effects by recognizing individual genetic variability in drug response. OBJECTIVES This article outlines the background of PGT, explains drug metabolism, and evaluates the impact of PGT. DESIGN A review of the literature since 2010 found 42 articles regarding PGT in clinical nursing settings on PubMed and ProQuest. RESULTS Despite continuing rises in health care costs, new biotechnology has led to a decrease in the cost of genetic sequencing and application of PGT to practice. CONCLUSION As PGT becomes increasingly prevalent, nurses should be knowledgeable of its purpose, possibilities, and potential limitations to provide accurate and up-to-date patient information.
Collapse
Affiliation(s)
- Elizabeth Burke
- 1 Elizabeth Burke, DNP, PMHNP, Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Rene Love
- 2 Rene Love, PhD, DNP, PMHNP-BC, FNAP, FAANP, University of Arizona School of Nursing, Tucson, AZ, USA
| | - Pam Jones
- 3 Pam Jones, DNP, NEA-BC, Vanderbilt School of Nursing, Nashville, TN, USA
| | - Taylor Fife
- 4 Taylor Fife, DNP, PMHNP-BC, Vanderbilt University School of Nursing, Nashville, TN, USA
| |
Collapse
|
25
|
Zhang JP, Robinson DG, Gallego JA, John M, Yu J, Addington J, Tohen M, Kane JM, Malhotra AK, Lencz T. Association of a Schizophrenia Risk Variant at the DRD2 Locus With Antipsychotic Treatment Response in First-Episode Psychosis. Schizophr Bull 2015; 41:1248-55. [PMID: 26320194 PMCID: PMC4601717 DOI: 10.1093/schbul/sbv116] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Findings from the Psychiatric Genomics Consortium genome-wide association study (GWAS) showed that variation at the DRD2 locus is associated with schizophrenia risk. However, the functional significance of rs2514218, the top DRD2 single nucleotide polymorphism in the GWAS, is unknown. Dopamine D2 receptor binding is a common mechanism of action for all antipsychotic drugs, and DRD2 variants were related to antipsychotic response in previous studies. The present study examined whether rs2514218 genotype could predict antipsychotic response, including efficacy and adverse events, in a cohort of patients with first episode of psychosis treated with either risperidone or aripiprazole for 12 weeks. Subjects were genotyped using the Illumina Infinium HumanOmniExpressExome array platform. After standard quality control, data from 100 subjects (49 randomly assigned to treatment with aripiprazole and 51 assigned to risperidone) was available for analysis. Subjects were assessed for psychotic symptomatology and medication-related adverse events weekly for 4 weeks, then biweekly for 8 weeks. Linear mixed model analysis revealed that the homozygotes for the risk (C) allele at rs2514218 had significantly greater reduction in positive symptoms during 12 weeks of treatment compared to the T allele carriers. In the aripiprazole group, C/C homozygotes also reported more akathisia than the T allele carriers, while in the risperidone group, male T allele carriers demonstrated greater prolactin elevations compared to male C/C homozygotes. These findings suggest that the schizophrenia risk variant at the DRD2 locus (or another variant in close proximity) is associated with observable differences in response to treatments which reduce striatal dopamine signaling.
Collapse
Affiliation(s)
| | | | | | | | - Jin Yu
- Division of Psychiatry Research, Department of Psychiatry, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, NY
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, NM
| | | | | | | |
Collapse
|
26
|
Affiliation(s)
- Robert Klitzman
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY
| |
Collapse
|
27
|
The Role of Pharmacogenomics to Guide Treatment in Mood and Anxiety Disorders. Curr Behav Neurosci Rep 2015. [DOI: 10.1007/s40473-015-0048-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
28
|
Trinidad SB, Coffin TB, Fullerton SM, Ralston J, Jarvik GP, Larson EB. "Getting off the Bus Closer to Your Destination": Patients' Views about Pharmacogenetic Testing. Perm J 2015; 19:21-7. [PMID: 26057686 DOI: 10.7812/tpp/15-046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The authors conducted focus groups with patients prescribed antidepressants (pilot session plus 2 focus groups, n = 27); patients prescribed carbamazepine (2 focus groups, n = 17); and healthy patients (2 focus groups, n = 17). Although participants understood the potential advantages of pharmacogenetic testing, many felt that the risks (discrimination, stigmatization, physician overreliance on genomic results, and denial of certain medications) may outweigh the benefits. These concerns were shared across groups but were more strongly expressed among participants with chronic mental health diagnoses.
Collapse
Affiliation(s)
- Susan Brown Trinidad
- Research Scientist in Bioethics and Humanities at the University of Washington in Seattle.
| | - Tara B Coffin
- Doctoral Candidate in the Institute for Public Health Genetics at the University of Washington in Seattle.
| | - Stephanie M Fullerton
- Associate Professor in Bioethics and Humanities at the University of Washington in Seattle.
| | - James Ralston
- Associate Investigator at the Group Health Research Institute in Seattle, WA.
| | - Gail P Jarvik
- Professor and Head of the Division of Medical Genetics at the University of Washington in Seattle.
| | - Eric B Larson
- Executive Director and Senior Investigator at the Group Health Research Institute in Seattle, WA.
| |
Collapse
|
29
|
Hohmann S, Adamo N, Lahey BB, Faraone SV, Banaschewski T. Genetics in child and adolescent psychiatry: methodological advances and conceptual issues. Eur Child Adolesc Psychiatry 2015; 24:619-34. [PMID: 25850999 DOI: 10.1007/s00787-015-0702-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 03/06/2015] [Indexed: 10/23/2022]
Abstract
Discovering the genetic basis of early-onset psychiatric disorders has been the aim of intensive research during the last decade. We will first selectively summarize results of genetic research in child and adolescent psychiatry by using examples from different disorders and discuss methodological issues, emerging questions and future directions. In the second part of this review, we will focus on how to link genetic causes of disorders with physiological pathways, discuss the impact of genetic findings on diagnostic systems, prevention and therapeutic interventions. Finally we will highlight some ethical aspects connected to genetic research in child and adolescent psychiatry. Advances in molecular genetic methods have led to insights into the genetic architecture of psychiatric disorders, but not yet provided definite pathways to pathophysiology. If replicated, promising findings from genetic studies might in some cases lead to personalized treatments. On the one hand, knowledge of the genetic basis of disorders may influence diagnostic categories. On the other hand, models also suggest studying the genetic architecture of psychiatric disorders across diagnoses and clinical groups.
Collapse
Affiliation(s)
- Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | | | | | | | | |
Collapse
|
30
|
Rovaris DL, Mota NR, da Silva BS, Girardi P, Victor MM, Grevet EH, Bau CH, Contini V. Should we keep on? Looking into pharmacogenomics of ADHD in adulthood from a different perspective. Pharmacogenomics 2015; 15:1365-81. [PMID: 25155937 DOI: 10.2217/pgs.14.95] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A considerable proportion of adults with attention-deficit/hyperactivity disorder (ADHD) do not respond to the treatment with methylphenidate. This scenario could be due to inherited interindividual differences that may alter pharmacologic treatment response. In this sense, in 2012 we conducted a systematic search on PUBMED-indexed literature for articles containing information about pharmacogenomics of ADHD in adults. Five studies were found on methylphenidate pharmacogenomics and the only significant association was reported by one particular study. However, this single association with the SLC6A3 gene was not replicated in two subsequent reports. In the present review, although we could not find additional pharmacogenomics studies, we discuss these up-to-date findings and suggest new approaches for this field. Additionally, using systeomic-oriented databases, we provide a broad picture of new possible candidate genes as well as potential gene-gene interactions to be investigated in pharmacogenomics of persistent ADHD.
Collapse
Affiliation(s)
- Diego L Rovaris
- Departament of Genetics, Instituto de Biociências, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Ma Y, Li B, Wang C, Zhang W, Rao Y, Han S. Allelic variation in 5-HTTLPR and the effects of citalopram on the emotional neural network. Br J Psychiatry 2015; 206:385-92. [PMID: 25745133 DOI: 10.1192/bjp.bp.114.150128] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/15/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, which selectively block serotonin transporter (5-HTT) activity, are widely used in the treatment of depression and anxiety disorders. Numerous neuroimaging studies have examined the effects of SSRIs on emotional processes. However, there are considerable inter-individual differences in SSRI effect, and a recent meta-analysis further revealed discrepant effects of acute SSRI administration on neural responses to negative emotions in healthy adults. AIMS We examined how a variant of the serotonin-transporter polymorphism (5-HTTLPR), which affects the expression and function of 5-HTT, influenced the acute effects of an SSRI (citalopram) on emotion-related brain activity in healthy adults. METHOD Combining genetic neuroimaging, pharmacological technique and a psychological paradigm of emotion recognition, we scanned the short/short (s/s) and long/long (l/l) variants of 5-HTTLPR during perception of fearful, happy and neutral facial expressions after the acute administration of an SSRI (i.e. 30 mg citalopram administered orally) or placebo administration. RESULTS We found that 5-HTTLPR modulated the acute effects of citalopram on neural responses to negative emotions. Specifically, relative to placebo, citalopram increased amygdala and insula activity in l/l but not s/s homozygotes during perception of fearful faces. Similar analyses of brain activity in response to happy faces did not show any significant effects. CONCLUSIONS Our combined pharmacogenetic and functional imaging results provide a neurogenetic mechanism for discrepant acute effects of SSRIs.
Collapse
Affiliation(s)
- Yina Ma
- Yina Ma, PhD, Department of Psychology, Peking University, China, and Lieber Institute for Brain Development, Johns Hopkins University School of Medicine, Baltimore, USA; Bingfeng Li, BS, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Chenbo Wang, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Wenxia Zhang, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Yi Rao, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Shihui Han, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Bingfeng Li
- Yina Ma, PhD, Department of Psychology, Peking University, China, and Lieber Institute for Brain Development, Johns Hopkins University School of Medicine, Baltimore, USA; Bingfeng Li, BS, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Chenbo Wang, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Wenxia Zhang, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Yi Rao, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Shihui Han, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Chenbo Wang
- Yina Ma, PhD, Department of Psychology, Peking University, China, and Lieber Institute for Brain Development, Johns Hopkins University School of Medicine, Baltimore, USA; Bingfeng Li, BS, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Chenbo Wang, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Wenxia Zhang, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Yi Rao, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Shihui Han, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Wenxia Zhang
- Yina Ma, PhD, Department of Psychology, Peking University, China, and Lieber Institute for Brain Development, Johns Hopkins University School of Medicine, Baltimore, USA; Bingfeng Li, BS, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Chenbo Wang, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Wenxia Zhang, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Yi Rao, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Shihui Han, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Yi Rao
- Yina Ma, PhD, Department of Psychology, Peking University, China, and Lieber Institute for Brain Development, Johns Hopkins University School of Medicine, Baltimore, USA; Bingfeng Li, BS, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Chenbo Wang, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Wenxia Zhang, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Yi Rao, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Shihui Han, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| | - Shihui Han
- Yina Ma, PhD, Department of Psychology, Peking University, China, and Lieber Institute for Brain Development, Johns Hopkins University School of Medicine, Baltimore, USA; Bingfeng Li, BS, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Chenbo Wang, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Wenxia Zhang, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Yi Rao, PhD, Peking-Tsinghua Center for Life Sciences at School of Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China; Shihui Han, PhD, Department of Psychology and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
| |
Collapse
|
32
|
Harrison PJ. The current and potential impact of genetics and genomics on neuropsychopharmacology. Eur Neuropsychopharmacol 2015; 25:671-81. [PMID: 23528807 DOI: 10.1016/j.euroneuro.2013.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 01/30/2013] [Accepted: 02/22/2013] [Indexed: 01/19/2023]
Abstract
One justification for the major scientific and financial investments in genetic and genomic studies in medicine is their therapeutic potential, both for revealing novel targets for drugs which treat the disease process, as well as allowing for more effective and safe use of existing medications. This review considers the extent to which this promise has yet been realised within psychopharmacology, how things are likely to develop in the foreseeable future, and the key issues involved. It draws primarily on examples from schizophrenia and its treatments. One observation is that there is evidence for a range of genetic influences on different aspects of psychopharmacology in terms of discovery science, but far less evidence that meets the standards required before such discoveries impact upon clinical practice. One reason is that results reveal complex genetic influences that are hard to replicate and usually of very small effect. Similarly, the slow progress being made in revealing the genes that underlie the major psychiatric syndromes hampers attempts to apply the findings to identify novel drug targets. Nevertheless, there are some intriguing positive findings of various kinds, and clear potential for genetics and genomics to play an increasing and major role in psychiatric drug discovery.
Collapse
Affiliation(s)
- Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford OX3 7JX, United Kingdom.
| |
Collapse
|
33
|
Drozda K, Müller DJ, Bishop JR. Pharmacogenomic testing for neuropsychiatric drugs: current status of drug labeling, guidelines for using genetic information, and test options. Pharmacotherapy 2015; 34:166-84. [PMID: 24523097 DOI: 10.1002/phar.1398] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Advancements in pharmacogenomics have introduced an increasing number of opportunities to bring personalized medicine into clinical practice. Understanding how and when to use this technology to guide pharmacotherapy used to treat psychiatric and neurological (neuropsychiatric) conditions remains a challenge for many clinicians. Currently, guidelines exist to assist clinicians in the use of existing genetic information for drug selection and/or dosing for the tricyclic antidepressants, carbamazepine, and phenytoin. Additional language in the product labeling suggests that genetic information may also be useful for determining the starting and target doses, as well as drug interaction potential, for a number of other drugs. In this review, we outline the current status of pharmacogenomic testing for neuropsychiatric drugs as it pertains to information contained in drug labeling, consensus guidelines, and test panels, as well as considerations related to obtaining tests for patients.
Collapse
Affiliation(s)
- Katarzyna Drozda
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois
| | | | | |
Collapse
|
34
|
Dubovsky SL. The usefulness of genotyping cytochrome P450 enzymes in the treatment of depression. Expert Opin Drug Metab Toxicol 2015; 11:369-79. [PMID: 25554071 DOI: 10.1517/17425255.2015.998996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Pharmacogenomics, which is derived from genome-wide association studies (GWAS), and pharmacogenetics, which involves candidate gene association studies (CGASs), are proving increasingly useful in personalized cancer care. Research in psychiatric applications has primarily involved genetic polymorphisms of P450 CYP enzymes, which mediate oxidative metabolism, particularly CYP2D6, which is involved in the metabolism of at least 30 psychotropic medications. This work has been supplemented by genotyping of proteins for the drug efflux pump P-glycoprotein (P-gp), serotonin receptors, and the serotonin reuptake pump. AREAS COVERED This review covers principles of pharmacogenetics and pharmacogenomics, previous analyses of pharmacokinetic and pharmacodynamics studies, newer studies of the predictive value of genetic testing in the treatment of depression, obstacles to implementation of genetic testing in predicting treatment response and side effects, and suggestions for future research. EXPERT OPINION Studies of multiple genes have produced some positive results in groups of patients, but genetic testing does not yet seem to be applicable to choosing medications for a specific patient.
Collapse
Affiliation(s)
- Steven L Dubovsky
- University at Buffalo, Department of Psychiatry , 462 Grider St, Buffalo, NY 14215 , USA +1 716 898 5940 ; +1 716 898 4538 ;
| |
Collapse
|
35
|
Seo I, Suh SI, Suh MH, Baek WK. Genome-wide association study of medication adherence in chronic diseases in the korean population. Genomics Inform 2014; 12:121-6. [PMID: 25317111 PMCID: PMC4196376 DOI: 10.5808/gi.2014.12.3.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 07/18/2014] [Accepted: 07/20/2014] [Indexed: 11/20/2022] Open
Abstract
Medication adherence is generally defined as the extent of voluntary cooperation of a patient in taking medicine as prescribed. Adherence to long-term treatment with chronic disease is essential for reducing disease comorbidity and mortality. However, medication non-adherence in chronic disease averages 50%. This study was conducted a genome-wide association study to identify the genetic basis of medication adherence. A total of 235 medication non-adherents and 1,067 medication adherents with hypertension or diabetes were used from the Korean Association Resource project data according to the self-reported treatment status of each chronic disease, respectively. We identified four single nucleotide polymorphisms with suggestive genome-wide association. The most significant single nucleotide polymorphism was rs6978712 (chromosome 7, p = 4.87 × 10-7), which is located proximal to the GCC1 gene, which was previously implicated in decision-making capability in drug abusers. Two suggestive single nucleotide polymorphisms were in strong linkage disequilibrium (r2 > 0.8) with rs6978712. Thus, in the aspect of decision-making in adherence behavior, the association between medication adherence and three loci proximal to the GCC1 gene seems worthy of further research. However, to overcome a few limitations in this study, defining the standardized phenotype criteria for self-reported adherence should be performed before replicating association studies.
Collapse
Affiliation(s)
- Incheol Seo
- Department of Microbiology, Keimyung University School of Medicine, Daegu 704-701, Korea
| | - Seong-Il Suh
- Department of Microbiology, Keimyung University School of Medicine, Daegu 704-701, Korea
| | - Min-Ho Suh
- Department of Microbiology, Keimyung University School of Medicine, Daegu 704-701, Korea
| | - Won-Ki Baek
- Department of Microbiology, Keimyung University School of Medicine, Daegu 704-701, Korea
| |
Collapse
|
36
|
Abstract
The disciplines of developmental psychopathology and behavior genetics are concerned with many of the same questions about the etiology and course of normal and abnormal behavior and about the factors that promote typical development despite the presence of risk. The goal of this paper is to summarize how research in behavior genetics has shed light on questions that are central to developmental psychopathology. We briefly review the origins of behavior genetics, summarize the findings that have been gleaned from several decades of quantitative and molecular genetics research, and describe future directions for research that will delineate gene function as well as pathways from genes to brain to behavior. The importance of environmental contributions, at both genetic and epigenetic levels, will be discussed. We conclude that behavior genetics has made significant contributions to developmental psychopathology by documenting the interplay among risk and protective factors at multiple levels of the organism, by clarifying the causal status of risk exposures, and by identifying factors that account for change and stability in psychopathology. As the tools to identify gene function become increasingly sophisticated, and as behavioral geneticists become increasingly interdisciplinary in their scope, the field is poised to make ever greater contributions to our understanding of typical and atypical development.
Collapse
|
37
|
Jenkins A, Apud JA, Zhang F, Decot H, Weinberger DR, Law AJ. Identification of candidate single-nucleotide polymorphisms in NRXN1 related to antipsychotic treatment response in patients with schizophrenia. Neuropsychopharmacology 2014; 39:2170-8. [PMID: 24633560 PMCID: PMC4104334 DOI: 10.1038/npp.2014.65] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/20/2014] [Accepted: 03/09/2014] [Indexed: 12/22/2022]
Abstract
Neurexins are presynaptic neuronal adhesion molecules that interact with postsynaptic neuroligins to form an inter-synaptic complex required for synaptic specification and efficient neurotransmission. Deletions and point mutations in the neurexin 1 (NRXN1) gene are associated with a broad spectrum of neuropsychiatric and neurodevelopmental disorders, including autism, intellectual disability, epilepsy, developmental delay, and schizophrenia. Recently, small nucleotide polymorphisms in NRXN1 have been associated with antipsychotic drug response in patients with schizophrenia. Based on previous suggestive evidence of an impact on clozapine response in patients with schizophrenia, we conducted an association study of NRXN1 polymorphisms (rs12467557 and rs10490162) with antipsychotic treatment response in 54 patients with schizophrenia in a double blind, placebo-controlled NIMH inpatient crossover trial and examined for association with risk for schizophrenia in independent case-control and family-based clinical cohorts. Pharmacogenetic analysis in the placebo controlled trial revealed significant association of rs12467557and rs10490162 with drug response, whereby individuals homozygous for the A allele, at either SNP, showed significant improvement in positive symptoms, general psychopathology, thought disturbance, and negative symptoms, whereas patients carrying the G allele showed no overall response. Although we did not find evidence of the same NRXN1 SNPs being associated with results of the NIMH sponsored CATIE trial, other SNPs showed weakly positive signals. The family and case-control analyses for schizophrenia risk were negative. Our results provide confirmatory evidence of genetically determined differences in drug response in patients with schizophrenia related to NRXN1 variation. Furthermore, these findings potentially implicate NRXN1 in the therapeutic actions of antipsychotic drugs.
Collapse
Affiliation(s)
- Aaron Jenkins
- Clinical Brain Disorders Branch, Genes, Cognition and Psychosis Program, National Institute of Mental Health, National Institute of Health, National Institutes of Health, Bethesda, MD, USA,University of Kentucky College of Medicine, Lexington, KY, USA
| | - José A Apud
- Clinical Brain Disorders Branch, Genes, Cognition and Psychosis Program, National Institute of Mental Health, National Institute of Health, National Institutes of Health, Bethesda, MD, USA
| | - Fengyu Zhang
- Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, MD, USA
| | - Heather Decot
- Clinical Brain Disorders Branch, Genes, Cognition and Psychosis Program, National Institute of Mental Health, National Institute of Health, National Institutes of Health, Bethesda, MD, USA
| | - Daniel R Weinberger
- Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, MD, USA,Departments of Psychiatry, Neurology, Neuroscience and the McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amanda J Law
- Departments of Psychiatry and Cell and Developmental Biology, University of Colorado, School of Medicine, Aurora, CO, USA,Departments of Psychiatry and Cell and Developmental Biology, University of Colorado, School of Medicine, Mailstop 8344, RC1 North, RM. 8101, Aurora, CO 80045, USA, Tel: +1 303 724 4418, Fax: +1 303 724 4425, E-mail:
| |
Collapse
|
38
|
Chen ACH, Davis CM, Kahler CW, Kuerbis AN, Covault J, Kranzler HR, Morgenstern J. 5-HTTLPR moderates naltrexone and psychosocial treatment responses in heavy drinking men who have sex with men. Alcohol Clin Exp Res 2014; 38:2362-8. [PMID: 25070809 DOI: 10.1111/acer.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/11/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND A functional polymorphism (5-HTTLPR) in the promoter region of the serotonin transporter gene has been widely studied as a risk factor and moderator of treatment for a variety of psychopathologic conditions. To evaluate whether 5-HTTLPR moderates the effects of treatment to reduce heavy drinking, we studied 112 high-functioning European-American men who have sex with men (MSM). Subjects participated in a randomized clinical trial of naltrexone (NTX) and cognitive behavioral therapy (CBT) for problem drinking. METHODS Subjects were treated for 12 weeks with 100 mg/d of oral NTX or placebo (PBO). All participants received medical management with adjusted brief behavioral compliance enhancement treatment (BBCET) alone or in combination with modified behavioral self-control therapy (MBSCT; an amalgam of motivational interviewing and CBT). Participants were genotyped for the tri-allelic 5-HTTLPR polymorphism (i.e., low-activity S' or high-activity L' alleles). RESULTS During treatment, the number of weekly heavy drinking days (HDD; defined as 5 or more standard drinks per day) was significantly lower in subjects with the L'L' (N = 26, p = 0.015) or L'S' (N = 52, p = 0.016) genotype than those with the S'S' (N = 34) genotype regardless of treatment type. There was a significant interaction of genotype with treatment: For subjects with the S'S' genotype, the effects of MBSCT or NTX on HDD were significantly greater than the minimal intervention (i.e., BBCET or PBO, p = 0.007 and p = 0.049, respectively). In contrast, for subjects with 1 or 2 L' alleles, the effects of the more intensive psychosocial treatment (MBSCT) or NTX did not significantly differ from BBCET or PBO. CONCLUSIONS These preliminary findings support the utility of the 5-HTTLPR polymorphism for personalizing treatment selection in problem drinkers.
Collapse
Affiliation(s)
- Andrew C H Chen
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; Research Foundation for Mental Hygiene, Inc., New York State Psychiatric Institute, New York, New York
| | | | | | | | | | | | | |
Collapse
|
39
|
Kohlrausch FB. Pharmacogenetics in schizophrenia: a review of clozapine studies. BRAZILIAN JOURNAL OF PSYCHIATRY 2014; 35:305-17. [PMID: 24142094 DOI: 10.1590/1516-4446-2012-0970] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 12/19/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Clozapine is quite effective to treat schizophrenia, but its use is complicated by several factors. Although many patients respond to antipsychotic therapy, about 50% of them exhibit inadequate response, and ineffective medication trials may entail weeks of unremitted illness, potential adverse drug reactions, and treatment nonadherence. This review of the literature sought to describe the main pharmacogenetic studies of clozapine and the genes that potentially influence response to treatment with this medication in schizophrenics. METHODS We searched the PubMed database for studies published in English in the last 20 years using keywords related to the topic. RESULTS AND CONCLUSIONS Our search yielded 145 studies that met the search and selection criteria. Of these, 21 review articles were excluded. The 124 studies included for analysis showed controversial results. Therefore, efforts to identify key gene mechanisms that will be useful in predicting clozapine response and side effects have not been fully successful. Further studies with new analysis approaches and larger sample sizes are still required.
Collapse
|
40
|
Chen CH, Lee CS, Lee MTM, Ouyang WC, Chen CC, Chong MY, Wu JY, Tan HKL, Lee YC, Chuo LJ, Chiu NY, Tsang HY, Chang TJ, Lung FW, Chiu CH, Chang CH, Chen YS, Hou YM, Chen CC, Lai TJ, Tung CL, Chen CY, Lane HY, Su TP, Feng J, Lin JJ, Chang CJ, Teng PR, Liu CY, Chen CK, Liu IC, Chen JJ, Lu T, Fan CC, Wu CK, Li CF, Wang KHT, Wu LSH, Peng HL, Chang CP, Lu LS, Chen YT, Cheng ATA. Variant GADL1 and response to lithium therapy in bipolar I disorder. N Engl J Med 2014; 370:119-28. [PMID: 24369049 DOI: 10.1056/nejmoa1212444] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lithium has been a first-line choice for maintenance treatment of bipolar disorders to prevent relapse of mania and depression, but many patients do not have a response to lithium treatment. METHODS We selected subgroups from a sample of 1761 patients of Han Chinese descent with bipolar I disorder who were recruited by the Taiwan Bipolar Consortium. We assessed their response to lithium treatment using the Alda scale and performed a genomewide association study on samples from one subgroup of 294 patients with bipolar I disorder who were receiving lithium treatment. We then tested the single-nucleotide polymorphisms (SNPs) that showed the strongest association with a response to lithium for association in a replication sample of 100 patients and tested them further in a follow-up sample of 24 patients. We sequenced the exons, exon-intron boundaries, and part of the promoter of the gene encoding glutamate decarboxylase-like protein 1 (GADL1) in 94 patients who had a response to lithium and in 94 patients who did not have a response in the genomewide association sample. RESULTS Two SNPs in high linkage disequilibrium, rs17026688 and rs17026651, that are located in the introns of GADL1 showed the strongest associations in the genomewide association study (P=5.50×10(-37) and P=2.52×10(-37), respectively) and in the replication sample of 100 patients (P=9.19×10(-15) for each SNP). These two SNPs had a sensitivity of 93% for predicting a response to lithium and differentiated between patients with a good response and those with a poor response in the follow-up cohort. Resequencing of GADL1 revealed a novel variant, IVS8+48delG, which lies in intron 8 of the gene, is in complete linkage disequilibrium with rs17026688 and is predicted to affect splicing. CONCLUSIONS Genetic variations in GADL1 are associated with the response to lithium maintenance treatment for bipolar I disorder in patients of Han Chinese descent. (Funded by Academia Sinica and others.).
Collapse
|
41
|
DeRubeis RJ, Cohen ZD, Forand NR, Fournier JC, Gelfand LA, Lorenzo-Luaces L. The Personalized Advantage Index: translating research on prediction into individualized treatment recommendations. A demonstration. PLoS One 2014; 9:e83875. [PMID: 24416178 PMCID: PMC3885521 DOI: 10.1371/journal.pone.0083875] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 11/09/2013] [Indexed: 02/08/2023] Open
Abstract
Background Advances in personalized medicine require the identification of variables that predict differential response to treatments as well as the development and refinement of methods to transform predictive information into actionable recommendations. Objective To illustrate and test a new method for integrating predictive information to aid in treatment selection, using data from a randomized treatment comparison. Method Data from a trial of antidepressant medications (N = 104) versus cognitive behavioral therapy (N = 50) for Major Depressive Disorder were used to produce predictions of post-treatment scores on the Hamilton Rating Scale for Depression (HRSD) in each of the two treatments for each of the 154 patients. The patient's own data were not used in the models that yielded these predictions. Five pre-randomization variables that predicted differential response (marital status, employment status, life events, comorbid personality disorder, and prior medication trials) were included in regression models, permitting the calculation of each patient's Personalized Advantage Index (PAI), in HRSD units. Results For 60% of the sample a clinically meaningful advantage (PAI≥3) was predicted for one of the treatments, relative to the other. When these patients were divided into those randomly assigned to their “Optimal” treatment versus those assigned to their “Non-optimal” treatment, outcomes in the former group were superior (d = 0.58, 95% CI .17—1.01). Conclusions This approach to treatment selection, implemented in the context of two equally effective treatments, yielded effects that, if obtained prospectively, would rival those routinely observed in comparisons of active versus control treatments.
Collapse
Affiliation(s)
- Robert J. DeRubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Zachary D. Cohen
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Nicholas R. Forand
- Department of Psychiatry, The Ohio State University, Columbus, Ohio, United States of America
| | - Jay C. Fournier
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Lois A. Gelfand
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Lorenzo Lorenzo-Luaces
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| |
Collapse
|
42
|
Dorfman R, Khayat Z, Sieminowski T, Golden B, Lyons R. Application of personalized medicine to chronic disease: a feasibility assessment. Clin Transl Med 2013; 2:16. [PMID: 24351097 PMCID: PMC3878365 DOI: 10.1186/2001-1326-2-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/25/2013] [Indexed: 02/04/2023] Open
Abstract
Personalized Medicine has the potential to improve health outcomes and reduce the cost of care; however its adoption has been slow in Canada. Bridgepoint Health is a complex continuous care provider striving to reduce the burden of polypharmacy in chronic patients. The main goal of the study was to explore the feasibility of utilizing personalized medicine in the treatment of chronic complex patients as a preliminary institutional health technology assessment. We analyzed stroke treatment optimization as a clinical indication that could serve as a "proof of concept" for the widespread implementation of pharmacogenetics. The objectives of the study were three-fold:1. Review current practice in medication administration for stroke treatment at Bridgepoint Health2. Critically analyze evidence that pharmacogenetic testing could (or could not) enhance drug selection and treatment efficacy for stroke patients;3. Assess the cost-benefit potential of a pharmacogenetic intervention for stroke.Review current practice in medication administration for stroke treatment at Bridgepoint HealthCritically analyze evidence that pharmacogenetic testing could (or could not) enhance drug selection and treatment efficacy for stroke patients;Assess the cost-benefit potential of a pharmacogenetic intervention for stroke.We conducted a review of stroke treatment practices at Bridgepoint Health, scanned the literature for drug-gene and drug-outcome interactions, and evaluated the potential consequences of pharmacogenetic testing using the ACCE model.There is a substantial body of evidence suggesting that pharmacogenetic stratification of stroke treatment can improve patient outcomes in the long-term, and provide substantial efficiencies for the healthcare system in the short-term. Specifically, pharmacogenetic stratification of antiplatelet and anticoagulant therapies for stroke patients may have a major impact on the risk of disease recurrence, and thus should be explored further for clinical application. Bridgepoint Health, and other healthcare institutions taking this path, should consider launching pilot projects to assess the practical impact of pharmacogenetics to optimize treatment for chronic continuous care.
Collapse
Affiliation(s)
- Ruslan Dorfman
- Present Address: Geneyouin Inc, Maple, ON, Canada
- The Rotman School of Management, The University of Toronto, Toronto, ON, Canada
| | - Zayna Khayat
- The Rotman School of Management, The University of Toronto, Toronto, ON, Canada
- International Centre for Health Innovation, Richard Ivey School of Business, University of Western Ontario, London, ON, Canada
| | | | - Brian Golden
- International Centre for Health Innovation, Richard Ivey School of Business, University of Western Ontario, London, ON, Canada
| | - Renee Lyons
- Bridgepoint Chair in Complex Chronic Disease Research, TD Scientific Director, Bridgepoint Collaboratory for Research and Innovation, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
43
|
Dargani NV, Malhotra AK. Safety profile of iloperidone in the treatment of schizophrenia. Expert Opin Drug Saf 2013; 13:241-6. [PMID: 24206391 DOI: 10.1517/14740338.2014.854770] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Iloperidone is a novel antipsychotic medication approved for the treatment of schizophrenia in adults with efficacy similar to its class counterparts. The purpose of this article is to describe the safety profile of iloperidone and its clinical implications. AREAS COVERED A PubMed search was undertaken on May 10, 2013, using the keyword iloperidone. Of the 121 articles that resulted, those with primary sources of information, along with secondary sources with an emphasis on drug safety, were included in this article. Iloperidone was found to have lower extrapyramidal symptom (EPS) and akathisia rates compared to haloperidol and risperidone. Twelve percent of patients experienced clinically significant weight gain, largely during initiation phase of treatment. No other clinically significant metabolic abnormalities were observed. QTc interval was increased by 10 ms, comparable to the effect observed with ziprasidone. QTc prolongation was heightened under inhibition of CYP2D6 and CYP3A4. Orthostatic hypotension was a common effect seen in the first week of treatment. EXPERT OPINION The favorable EPS and akathisia profile of iloperidone makes it an attractive choice for patients whose compliance is limited by these effects. However, the slow titration schedule adapted to reduce orthostasis may limit the use of this agent in an acute setting.
Collapse
Affiliation(s)
- Navin V Dargani
- The Zucker Hillside Hospital, Hofstra North Shore-LIJ School of Medicine , 75-59 263rd Street, Glen Oaks, NY 11004 , USA +1 718 470 8012 ; +1 718 343 1659 ;
| | | |
Collapse
|
44
|
Buchanan J, Wordsworth S, Schuh A. Issues surrounding the health economic evaluation of genomic technologies. Pharmacogenomics 2013; 14:1833-47. [PMID: 24236483 PMCID: PMC3909837 DOI: 10.2217/pgs.13.183] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM Genomic interventions could enable improved disease stratification and individually tailored therapies. However, they have had a limited impact on clinical practice to date due to a lack of evidence, particularly economic evidence. This is partly because health economists are yet to reach consensus on whether existing methods are sufficient to evaluate genomic technologies. As different approaches may produce conflicting adoption decisions, clarification is urgently required. This article summarizes the methodological issues associated with conducting economic evaluations of genomic interventions. MATERIALS & METHODS A structured literature review was conducted to identify references that considered the methodological challenges faced when conducting economic evaluations of genomic interventions. RESULTS Methodological challenges related to the analytical approach included the choice of comparator, perspective and timeframe. Challenges in costing centered around the need to collect a broad range of costs, frequently, in a data-limited environment. Measuring outcomes is problematic as standard measures have limited applicability, however, alternative metrics (e.g., personal utility) are underdeveloped and alternative approaches (e.g., cost-benefit analysis) underused. Effectiveness data quality is weak and challenging to incorporate into standard economic analyses, while little is known about patient and clinician behavior in this context. Comprehensive value of information analyses are likely to be helpful. CONCLUSION Economic evaluations of genomic technologies present a particular challenge for health economists. New methods may be required to resolve these issues, but the evidence to justify alternative approaches is yet to be produced. This should be the focus of future work in this field.
Collapse
Affiliation(s)
- James Buchanan
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Sarah Wordsworth
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, Oxfordshire, OX3 7LF, UK
| | - Anna Schuh
- Oxford Cancer & Haematology Centre, Churchill Hospital, Oxford, Oxfordshire, OX3 7LE, UK
| |
Collapse
|
45
|
Spencer B, Prainsack B, Rujescu D, Giegling I, Collier D, Gaughran F, MacCabe JH, Barr CL, Sigurdsson E, Stovring H, Malhotra A, Curran SR. Opening Pandora’s box in the UK: a hypothetical pharmacogenetic test for clozapine. Pharmacogenomics 2013; 14:1907-14. [DOI: 10.2217/pgs.13.182] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Clozapine is a uniquely efficacious antipsychotic drug in treatment-resistant schizophrenia. Its use is restricted due to adverse effects including a rare but dangerous reduction in neutrophils (agranulocytosis) and the mandatory hematological monitoring this entails in many countries. We review the statistical, ethical and legal issues arising from a hypothetical pharmacogenetic test for clozapine, using the UK as an exemplary case for consideration. Our key findings include: a consideration of the probabilistic results that a pharmacogenetic test may return; the impact on drug licensing; and the potential for pharmacogenetic tests for clozapine being used without consent under the UK’s legal framework. We make recommendations regarding regulatory changes applicable to the special case of pharmacogenetic testing in clozapine treatment.
Collapse
Affiliation(s)
| | - Barbara Prainsack
- Department of Social Science, Health & Medicine, King’s College London, London, UK
| | - Dan Rujescu
- Department of Psychiatry, University of Halle, Germany
| | - Ina Giegling
- Department of Psychiatry, University of Halle, Germany
| | - David A Collier
- Institute of Psychiatry, King’s College London, London, UK
- Eli Lilly & Company Ltd, Erl Wood, UK
| | - Fiona Gaughran
- South London & Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, King’s College London, London, UK
| | - James H MacCabe
- South London & Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, King’s College London, London, UK
| | - Cathy L Barr
- The Toronto Western Research Institute, Toronto, ON, Canada
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Engilbert Sigurdsson
- University of Iceland, Reykjavik, Iceland
- Department of Psychiatry, Landspitali-University Hospital, Reykjavik, Iceland
| | | | - Anil K Malhotra
- The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Hofstra North Shore-LIJ School of Medicine, Hemptead, NY, USA
| | - Sarah R Curran
- South London & Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, King’s College London, London, UK
| |
Collapse
|
46
|
Neuroimaging in psychiatric pharmacogenetics research: the promise and pitfalls. Neuropsychopharmacology 2013; 38:2327-37. [PMID: 23793356 PMCID: PMC3799069 DOI: 10.1038/npp.2013.152] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 06/10/2013] [Accepted: 06/10/2013] [Indexed: 12/22/2022]
Abstract
The integration of research on neuroimaging and pharmacogenetics holds promise for improving treatment for neuropsychiatric conditions. Neuroimaging may provide a more sensitive early measure of treatment response in genetically defined patient groups, and could facilitate development of novel therapies based on an improved understanding of pathogenic mechanisms underlying pharmacogenetic associations. This review summarizes progress in efforts to incorporate neuroimaging into genetics and treatment research on major psychiatric disorders, such as schizophrenia, major depressive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, and addiction. Methodological challenges include: performing genetic analyses in small study populations used in imaging studies; inclusion of patients with psychiatric comorbidities; and the extensive variability across studies in neuroimaging protocols, neurobehavioral task probes, and analytic strategies. Moreover, few studies use pharmacogenetic designs that permit testing of genotype × drug effects. As a result of these limitations, few findings have been fully replicated. Future studies that pre-screen participants for genetic variants selected a priori based on drug metabolism and targets have the greatest potential to advance the science and practice of psychiatric treatment.
Collapse
|
47
|
Abstract
Over the past decade, considerable advances have been made in understanding genetic influences on eating pathology. Eating disorders aggregate in families, and twin studies reveal that additive genetic factors account for approximately 40% to 60% of liability to anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Molecular genetics studies have been undertaken to identify alterations in deoxyribonucleic acid sequence and/or gene expression that may be involved in the pathogenesis of disordered eating behaviors, symptoms, and related disorders and to uncover potential genetic variants that may contribute to variability of treatment response. This article provides an in-depth review of the scientific literature on the genetics of AN, BN, and BED including extant studies, emerging hypotheses, future directions, and clinical implications.
Collapse
Affiliation(s)
- Sara E Trace
- Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
| | | | | | | |
Collapse
|
48
|
Hunter AM, Leuchter AF, Power RA, Muthén B, McGrath PJ, Lewis CM, Cook IA, Garriock HA, McGuffin P, Uher R, Hamilton SP. A genome-wide association study of a sustained pattern of antidepressant response. J Psychiatr Res 2013; 47:1157-65. [PMID: 23726668 PMCID: PMC3710535 DOI: 10.1016/j.jpsychires.2013.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/25/2013] [Accepted: 05/02/2013] [Indexed: 02/06/2023]
Abstract
Genome-wide association studies (GWAS) have failed to replicate common genetic variants associated with antidepressant response, as defined using a single endpoint. Genetic influences may be discernible by examining individual variation between sustained versus unsustained patterns of response, which may distinguish medication effects from non-specific, or placebo responses to active medication. We conducted a GWAS among 1116 subjects with Major Depressive Disorder from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial who were characterized using Growth Mixture Modeling as showing a sustained versus unsustained pattern of clinical response over 12 weeks of treatment with citalopram. Replication analyses examined 585 subjects from the Genome-based Therapeutic Drugs for Depression (GENDEP) trial. The strongest association with sustained as opposed to unsustained response in STAR*D involved a single nucleotide polymorphism (SNP; rs10492002) within the acyl-CoA synthetase short-chain family member 3 gene (ACSS3, p-value=4.5×10(-6), odds ratio=0.61). No SNPs met our threshold for genome-wide significance. SNP data were available in GENDEP for 18 of the top 25 SNPs in STAR*D. The most replicable association was with SNP rs7816924 (p=0.008, OR=1.58); no SNP met the replication p-value threshold of 0.003. Joint analysis of these 18 SNPs resulted in the strongest signal coming from rs7816924 (p=2.11×10(-7)), which resides in chondroitin sulfate N-acetylgalactosaminyltransferase 1 gene (CSGALNACT1). An exploratory genetic pathway analysis revealed evidence for an involvement of the KEGG pathway of long-term potentiation (FDR=.02). Results suggest novel genetic associations to sustained response.
Collapse
Affiliation(s)
- Aimee M Hunter
- Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Mas S, Llerena A, Saíz J, Bernardo M, Lafuente A. Strengths and weaknesses of pharmacogenetic studies of antipsychotic drugs: the potential value of the PEPs study. Pharmacogenomics 2013; 13:1773-82. [PMID: 23171340 DOI: 10.2217/pgs.12.159] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The successful application of pharmacogenetics in routine clinical practice is still a long way from becoming a reality. In order to favor the transfer of pharmacogenetic results to clinical practice, especially in psychiatry, these studies must be optimized. This article reviews the strengths and weaknesses that characterize pharmacogenetic studies in psychiatry and condition their implementation in clinical practice. We also include recommendations for improving the design of pharmacogenetic studies, which may convert their limitations into strengths and facilitate the implementation of their results into clinical practice. Finally, we discuss the potential value of naturalistic, prospective, multicenter and coordinated projects such as the 'Phenotype-genotype and environmental interaction. Application of a predictive model in first psychotic episodes' (known as the PEPs study, from the Spanish abbreviation) in pharmacogenetic studies.
Collapse
Affiliation(s)
- Sergi Mas
- Department of Anatomic Pathology, Pharmacology & Microbiology, University of Barcelona, IDIBAPS, Casanova 143, E-08036 Barcelona, Spain
| | | | | | | | | |
Collapse
|
50
|
Liperoti R, Landi F. The Management of Behavioral and Psychological Symptoms of Dementia: The Need for Tailored Interventions. J Am Med Dir Assoc 2013; 14:306-7. [DOI: 10.1016/j.jamda.2013.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
|