PGx in Psy

Clinical Neuropsychiatry February 2011

2011-03-24T07:50:00.000-07:00

Please note the contents of Clinical Neuropsychiatry n. 1, February 2011
all papers free downloadable at http://www.clinicalneuropsychiatry.org/

Index<http://www.clinicalneuropsychiatry.org/pdf/00_index_1-11.pdf>
The ‘new psychopharmacologist’
edited by Thomas L. Schwartz

Notice for BAP members

2011-03-03T06:17:00.000-08:00

2012 SUMMER MEETING: SUNDAY 22 – WEDNESDAY 25 JULY

A major topic at BAP Council meetings is to decide on the symposium programme for the summer meeting, which we are all aware, is the showcase event for the BAP. To ensure that the meeting is successful we need to provide a programme that is topical, well balanced and that reflects the needs and interests of the BAP Members. The best way that this can be achieved is to have substantial input from the membership. You are encouraged to think seriously about the topics you would like to see in the summer meeting symposia and to put forward proposals. There are several factors that are important to address in choosing the topic and content of symposia and against which proposals are measured; these include:

* topical nature of the subject
* breadth of interest
* relevance to, and inclusion of, both clinical and preclinical psychopharmacology
* a lack of overlap with, or repetition of, recent BAP symposia
* four high-quality speakers (with ideally no more than one requiring a high travel cost)

Members who have ideas, whether tentative or clearly formulated, are strongly encouraged to discuss these with a member of Council.

Members are invited to submit proposals for symposia for the 2012 Summer Meeting. Proposals should be emailed to Susan Chandler (susan@bap.org.uk) by 7 March 2011. Proposals will be discussed by Council at their meeting on 16 March.

All proposals should include:

* Symposium Title
* A proposed chair
* Four proposed speakers with suggested titles
* A 200-word justification for including the symposium in the programme.

Full details of the 2011 Meeting, 24-27 July, are available here: http://bap.org.uk/summermeetinghome.php?meetingID=4.

EFNS Congress

2010-12-09T06:18:00.000-08:00

FYI

Submit Your Abstract Add to Calendar Scientific Programme EFNS Society

Save the Date!
September 10-13, 2011

We are pleased to announce the 15th Congress of the European Federation of Neurological Societies (EFNS 2011), which will be held in Budapest, Hungary, September 10-13, 2011.

Join over 5,000 colleagues at this key neurology congress for updates on the latest research, current clinical practices and treatments in the field.

EFNS 2011 will feature an advanced scientific programme with focused workshops, teaching courses and presentations led by a top international faculty.

www.efns.org/efns2011

Recent Psychopharmacology Papers of Interest

2009-02-20T14:23:00.000-08:00

1. Perroud N, Uher R, Marusic A, Rietschel M, Mors O, Henigsberg N, Hauser J, Maier W, Souery D, Placentino A, Szczepankiewicz A, Jorgensen L, Strohmaier J, Zobel A, Giovannini C, Elkin A, Gunasinghe C, Gray J, Campbell D, Gupta B, Farmer AE, McGuffin P, Aitchison KJ.
Suicidal ideation during treatment of depression with escitalopram and nortriptyline in genome-based therapeutic drugs for depression (GENDEP): a clinical trial. BMC Med. 2009 Oct 15;7:60. PMID: 19832967 [PubMed - indexed for MEDLINE] Free PMC Article Free
http://www.ncbi.nlm.nih.gov/pubmed/19832967
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768737
Related citations
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=19832967>

2. Uher R, Maier W, Hauser J, Marusic A, Schmael C, Mors O, Henigsberg N, Souery D, Placentino A, Rietschel M, Zobel A, Dmitrzak-Weglarz M, Petrovic A, Jorgensen L, Kalember P, Giovannini C, Barreto M, Elkin A, Landau S, Farmer A, Aitchison KJ, McGuffin P.
Differential efficacy of escitalopram and nortriptyline on dimensional measures of depression.
Br J Psychiatry. 2009 Mar;194(3):252-9. Erratum in: Br J Psychiatry. 2009 Jul;195(1):87.
PMID: 19252156 [PubMed - indexed for MEDLINE] Free Article
http://www.ncbi.nlm.nih.gov/pubmed/19252156
Related citations http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=19252156

3. Aitchison KJ, Basu A, McGuffin P, Craig I.
Psychiatry and the 'new genetics': hunting for genes for behaviour and drug response.
Br J Psychiatry. 2005 Feb;186:91-2. No abstract available.
PMID: 15684228 [PubMed - indexed for MEDLINE] Free Article
http://www.ncbi.nlm.nih.gov/pubmed/15684228
Related citations
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=15684228

4. Aitchison KJ, Munro J, Wright P, Smith S, Makoff AJ, Sachse C, Sham PC, Murray RM, Collier DA, Kerwin RW.
Failure to respond to treatment with typical antipsychotics is not associated with CYP2D6 ultrarapid hydroxylation.
Br J Clin Pharmacol. 1999 Sep;48(3):388-94.
PMID: 10510151 [PubMed - indexed for MEDLINE] Free PMC Article Free text http://www.ncbi.nlm.nih.gov/pubmed/10510151
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014339
Related citations
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=10510151
BMC Med. 2009 Oct 15;7:60.
PMID: 19832967 [PubMed - indexed for MEDLINE] Free PMC Article Free text
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2768737
Related citations
http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=link&linkname=pubmed_pubmed&uid=19832967

5. Keers R, Farmer AE, Aitchison KJ. Extracting a needle from a haystack: reanalysis of whole genome data reveals a readily translatable finding. Psychol Med, published Online by Cambridge University Press 12 Feb 2009, doi:10.1017/S0033291708005084.

The abstract and article can be downloaded at: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=4031716

6. KJ Aitchison, M Bienroth, J Cookson, R Gray, PM Haddad, B Moore, L Ratna, G Sullivan, D Taylor, M Taylor, and GM Goodwin. A UK consensus on the administration of aripiprazole for the treatment of mania. J Psychopharmacol first published on November 14, 2008 as doi:10.1177/0269881108098820

The article can be downloaded at:
http://jop.sagepub.com/pap.dtl

Or the abstract can be found at:
http://jop.sagepub.com/cgi/content/abstract/0269881108098820v1

7. Mir A, Shivakumar K, Williamson RJ, McAllister VDM, O’Keane V, Aitchison KJ. Change in sexual dysfunction on aripiprazole: a switching or add-on study. J Psychopharmacol 2008; 22; 244 originally published online Feb 28, 2008; DOI: 10.1177/0269881107082901

The full online version of this article can be found at: http://dx.doi.org/10.1177/0269881107082901

or abstract at: http://jop.sagepub.com/cgi/content/abstract/22/3/244

8. Ohlsen RI, Williamson R, Yusufi B, Mullan J, Irving D, Mukherjee S, Page E, Aitchison KJ, Barnes TRE. Interrater reliability of the Antipsychotic Non-Neurological Side-Effects Rating Scale measured in patients treated with clozapine. J Psychopharmacol 2008; 22; 323; DOI: 10.1177/0269881108091069

The online version of this article can be found at: http://dx.doi.org/10.1177/026988110891069

or abstract at: http://jop.sagepub.com/cgi/content/abstract/22/3/323
For a copy of the ANNSERS, please contact Professor TRE Barnes or Dr KJ Aitchison.

Conferences of Interest

2009-02-18T09:31:00.000-08:00

Annual Pharmacogenetics in Psychiatry Meeting (NY, 17-18 April 2009)
International Anxiety Disorders Symposium (Amsterdam, 27-28 May 2009)
Royal College of Psychiatrists Annual Meeting (BT Convention Centre, London, 2-5 June 2009)
Access, Availability and Choice – Treating People with Schizophrenia (Education and Training Centre, Royal College of Psychiatry, London, 23 June 2009)
BAP Summer Meeting (Oxford, 26-29 July 2009)
22nd ECNP Congress (Istanbul, 12-16 September 2009)
Schizophrenia: The Final Frontier (Institute of Psychiatry, London, 5-6 November 2009)

Special Issue in Pharmacoeconomics in honour of the late Prof. Rob Kerwin

2009-01-09T09:29:00.000-08:00

Current issue: Clinical Neuropsychiatry - n. 4 - August - 2008
Pharmacoeconomics
Katherine J. Aitchison and Paul McCrone

01 Editorial HOW FAR HAVE WE GOT IN PHARMACOECONOMICS FOR PSYCHIATRY AND WHERE ARE WE GOING? Paul McCrone, Katherine J. Aitchison, David Taylor

02 Paper ALL DRESSED UP AND KNOW WHERE TO GO: AN EXAMPLE OF HOW TO USE NET BENEFIT REGRESSION TO DO A COST-EFFECTIVENESS ANALYSIS WITH PERSON-LEVEL DATA (THE ‘A’ IN CEA) Jeffrey S. Hoch

03 Paper RETURNING TO THE ISSUE OF THE COST-EFFECTIVENESS OF ANTIPSYCHOTICS IN THE TREATMENT OF SCHIZOPHRENIA Ruth I. Ohlsen, David Taylor, Kopal Tandon, Katherine J. Aitchison

04 Paper ASSOCIATIONS BETWEEN NEGATIVE SYMPTOMS, SERVICE USE PATTERNS, AND COSTS IN PATIENTS WITH SCHIZOPHRENIA IN FIVE EUROPEAN COUNTRIES Martin Knapp, Paul McCrone, Oscar Leeuwenkamp

05 Paper PHARMACOGENETIC TESTING IN PSYCHIATRY: PHARMACOECONOMIC APPLICATIONS AND CONSIDERATIONS Renee Romeo, Katherine J. Aitchison, Delphine Capdevielle

PDFs of these articles are all freely downloadable at www.clinicalneuropsychiatry.org or by clicking on the above links.

Psychopharmacology for Perinatal Psychiatry

2008-03-05T13:47:00.000-08:00

A joint meeting of the Section of Perinatal Psychiatry and the Psychopharmacology Special Interest Group was held on 22nd November 2007, Royal College of Obstetricians and Gynaecologists, London: Psychotropic Prescribing in Pregnancy, Striving to “first do no harm.”
At the end of the meeting there was a "Round Table Discussion," arising from which it was suggested that a document recording the consensus views from this regarding "do not's" in terms of psychotropic prescribing in pregnancy and lactation be produced, and put on a blog, for discussion. This is available here:

Consensus views from Round Table Discussion at Joint Meeting of the Section of Perinatal Psychiatry and the Psychopharmacology Special Interest Group: Psychotropic Prescribing in Pregnancy, Striving to “first do no harm,” 22nd November 2007, Royal College of Obstetricians and Gynaecologists, London.

Do not:
• Forget to discuss with all women of reproductive age who
have serious mental illness (particularly bipolar disorder and
schizophrenia) their plans to reproduce, the problems to their mental health if they become pregnant or have a baby and the potential problems to a developing pregnancy related to their current medication
• Fail to recognise that women with bipolar disorder or a schizophrenia spectrum disorder will be at increased risk of gestational diabetes and should hence have appropriate monitoring (including serial BMIs and fasting glucoses where possible, or random glucoses or urine dipsticks where the former are not pragmatic)
• Forget to raise the issue of effective contraception if a woman is taking
clozapine, lithium, anticonvulsant mood stabilisers
• Prescribe anticonvulsant mood stabilisers or lithium in pregnancy unless there is no alternative
• Consider the possible adverse consequences of not prescribing a particular medication regime, especially antepartum
• Fail to take into account individual factors for each patient
• Use new drugs with currently insufficient safety data unless there are no alternatives
• Forget about appropriate supplementation, e.g. high-dose folate
• Fail to liaise and refer to other relevant disciplines, e.g. Neonatology and Paediatrics, and employ shared care protocols where possible
• Fail to use the National Teratology Information Service
• Discontinue or change medication in a postpartum breast-feeding mother (or in the immediate antepartum period) without adequate reason for doing so
• Oversedate a woman postpartum
• Prescribe clozapine to a breast-feeding mother
• Fail to monitor the newborn for blood dyscrasia should pregnancy have occurred on clozapine

Aitchison KJ, Baldwin D & Oates M: Document for discussion, 2008

In addition, text from Dr Baldwin's presentation at this conference (representing extracts from College Report CR142) are available here:

Unlicensed prescribing in pregnancy (from College Report CR 142)

• Wherever possible, women receiving psychotropic medication should carefully plan their pregnancies and discuss with their GP and psychiatrist prior to conception whether to continue, change or stop their medication. This is particularly important for women receiving treatment for serious mental illness and where there may be a significant risk of relapse following cessation of medication.

• Unless there are positive reasons not to do so, medication should be changed prior to conception to that which has the best safety profile in pregnancy.

• In general, because they have been in use for many years, there is more information available about the effects of older drugs compared to newer ones.

• Wherever possible, medication should be avoided in the first trimester. However, if women conceive whilst taking psychotropic medication it should not be abruptly withdrawn. A relapse may involve increased risks through a need to treat the relapse.

• Mild non-psychotic conditions are common in pregnancy and wherever possible psychological treatments are preferable to psychotropic medication. The threshold for prescribing psychotropic medication in pregnancy should be high and based on clear indications.

• Whilst the incidence of serious mental illness in pregnancy is lower than at other times, when these illnesses occur they should be treated energetically. The risk to mother and unborn child of not treating the illness may be higher than the potential risks of the medication.

• Pregnancy is not protective against a relapse of serious mental illness, particularly if medication has been stopped. Continuing medication is therefore in both the mother’s and the infant’s best interests. However particular attention needs to be paid to the choice of individual antipsychotic and mood stabilising agents.

• Psychiatrists, obstetricians and neonatal paediatricians should be aware of the potential of withdrawal effects in neonates if the mother has been taking antidepressants or antipsychotic medication prior to delivery.

• Doctors prescribing psychotropic medication to pregnant and breastfeeding women should ensure that they have the most up to date information possible. A good source of balanced and regularly updated information can be obtained from The National Teratology Information Service

• The lowest dose possible should be used in divided dosage and poly-pharmacy avoided.

• Doctors should always work in partnership with the women and their partners and be able to discuss the risks and benefits of their medication in a way that is easily understood.

• When prescribing medication in pregnancy or lactating women, the psychiatrist should clearly document the reasons why the medication is being prescribed, an indication that the risks and benefits have been addressed, that the woman has been involved in the decision and a note made of any advice or information received that has influenced the decision and choice of medication.

Further considerations when prescribing:

• Doctors might wish to discuss individual practice relating to unlicensed prescribing in their continuous professional development peer groups.

• Trusts might wish to audit local prescribing to gain information on the extent of, and reasons for, prescribing for unlicensed applications in individual patients.

• Doctors may wish to collaborate in evaluating the benefit and acceptability of prescribing for unlicensed applications in their practice, and submit the results of these assessments for publication in scientific journals.

• Faculties of The Royal College of Psychiatrists may wish to convene Faculty-specific working groups to consider in more detail the issue of prescribing for unlicensed applications in their patient groups.

• Research Unit of The Royal College of Psychiatrists may wish to commission large-scale research into prescribing for unlicensed applications in psychiatric practice.

Use of licensed medicines for unlicensed applications: Summary

• forms part of routine clinical practice in psychiatry

• is particularly common in certain patient groups

• can be done safely, without conferring additional risks

• can be a reflection of overall knowledge and competence

Recent Papers of Interest

An open trial of Omega-3 fatty acids for depression in pregnancy Freeman MP, Hibbeln JR, Wisner KL, et al.
Acta Neuropsychiatrica, Volume 18, Issue 1
http://dmmsclick.wiley.com/click.asp?p=4221094&m=14807&u=218261

Randomized dose-ranging pilot trial of omega-3 fatty acids for postpartum depression Freeman MP, Hibbeln JR, Wisner KL, et al.
Acta Psychiatrica Scandinavica, Volume 113, Issue 1
http://dmmsclick.wiley.com/click.asp?p=4221094&m=14807&u=218266

Gentile, Salvatore. Infant Safety With Antipsychotic Therapy in Breast-Feeding: A Systematic Review. (2008). J Clin Psychiatry. 69(4):666-73.

Abstract can be found at: http://www.ncbi.nlm.nih.gov/pubmed/18370569

Psychopharmacogenetics

2007-11-07T06:12:00.000-08:00

Background

Genetic factors play a significant role in predicting an individual’s response to a drug. The response may be the desired therapeutic effect of the drug and also may be the undesirable development of adverse effects. This relationship between genes and drug response interests the pharmacogeneticist. This article aims to give an overview of the exciting discoveries made so far in the field of psychiatry, particularly concerning the response to antidepressants and antipsychotics, as well as to mention some of the more recent findings. The ultimate goal of pharmacogenetics is to provide medication “tailored” to the individual based on their genetic profile, and although this may currently seem a distant target, it has already begun to raise ethical questions, which also are discussed.

Basu A, Tsapakis EM, Aitchison KJ. Current Psychiatry Reports 2004; 6: 134-142.
DOI: 10.1007/s19920-004-0053-5

Individual genetic variation accounts for some of the variability in response to drugs used routinely in clinical psychiatry. Psychopharmacogenetics focuses on how polymorphisms in genes affecting the mechanism of action of a drug’s effect and/or metabolism (both peripheral and central) can influence an individual’s clinical response to the drug, in terms of both therapeutic efficacy and adverse effects. Pharmacogenetics promises to be of substantial help in the field of psychiatric pharmacotherapy, but before research findings can be applied to clinical practice, ethical and methodological problems have to be addressed and overcome. This review summarises the most robust findings in the field and outlines how psychopharmacogenetic studies could lead to treatment individualisation.

Tsapakis EM, Basu A, Aitchison KJ. Clinical relevance of discoveries in psychopharmacogenetics. Advances in Psychiatric Treatment, 10:455-465.

GENDEP: A multicentre European pharmacogenomics study of antidepressants. http://gendep.iop.kcl.ac.uk/results.php