Personalized Medicine in Psychiatry最新文献

{"title":"A challenging case of catatonia during pregnancy","authors":"Natalie Martinez-Sosa,&nbsp;Joshua Delaney,&nbsp;Stephen McLeod-Bryant","doi":"10.1016/j.pmip.2020.100064","DOIUrl":"https://doi.org/10.1016/j.pmip.2020.100064","url":null,"abstract":"<div><p><span>Co-occurring pregnancy and catatonia<span> is a challenging combination to treat as the first line treatment for catatonia, </span></span>benzodiazepines<span><span><span>, have been shown to have negative effects on a fetus. ECT is another recommended treatment in this patient population but was not available on admission. The patient was treated with </span>risperidone and </span>lorazepam<span>, which was deemed ineffective, and memantine was started. Shortly after, ECT became available and in combination with memantine, catatonia was treated effectively.</span></span></p></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"23 ","pages":"Article 100064"},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.pmip.2020.100064","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91989357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining irritability as a diagnostic marker and a target for responsiveness","authors":"Erica Bell ,&nbsp;Gin S. Malhi","doi":"10.1016/j.pmip.2020.100067","DOIUrl":"10.1016/j.pmip.2020.100067","url":null,"abstract":"","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"23 ","pages":"Article 100067"},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.pmip.2020.100067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121785635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond antidepressant effects of deep brain stimulation – A systematic qualitative approach","authors":"Nenja K. Ziesen ,&nbsp;Hannah M. Kilian ,&nbsp;Thomas E. Schlaepfer","doi":"10.1016/j.pmip.2020.100063","DOIUrl":"https://doi.org/10.1016/j.pmip.2020.100063","url":null,"abstract":"<div><h3>Background</h3><p>In the field of psychiatric disorders Deep brain stimulation<span> (DBS) is an experimental treatment method for which not all causes and (long-term) effects have yet been clarified. Especially in this experimental stage any kind of information is necessary for an efficient use of this treatment method.</span></p></div><div><h3>Method</h3><p>Here, an interdisciplinary research approach was used to uncover <em>blind spots</em> of one's own research perspective. To this end, a psychological and psychiatric perspective was expanded including a sociological research approach. Within this sociological qualitative perspective, 524 pages of research material were generated, consisting of observation protocols and sketches as well as qualitative interviews with patients (N = 17) and the research team (N = 7). The data collection and field phase started in 03/2014 and ended in 07/2016, within FORESEE I and FORESEE II study (ClinicalTrials.gov Identifier: NCT01095263; NCT01778790).</p></div><div><h3>Results</h3><p>Two central concerns of the patients became visible: On the one hand, the striving for <em>normality</em> with the focus on the stimulation settings. On the other hand, the desire for <em>self-regulation</em> by means of technology in the event of a deterioration in mood. In addition, almost all patients report that they do not feel the technique and do not feel externally determined by the technique.</p></div><div><h3>Conclusion</h3><p>Regarding the focus of the current ethical-philosophical debate about potential external control and external determination by technology, this aspect was no issue for the patients interviewed. Accordingly, we propose to use this as an important source for add-on in future studies.</p></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"23 ","pages":"Article 100063"},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91989356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating genetic variation with DNA methylation at SKA2 rs7208505 in analyses of obsessive-compulsive disorder disease risk and symptom severity","authors":"Amanda J. Lisoway ,&nbsp;Clement C. Zai ,&nbsp;Arun K. Tiwari ,&nbsp;Akhil Nair ,&nbsp;Sasha Ebrahimi ,&nbsp;Vanessa F. Gonçalves ,&nbsp;Gwyneth Zai ,&nbsp;Zachary A. Kaminsky ,&nbsp;Margaret A. Richter ,&nbsp;James L. Kennedy","doi":"10.1016/j.pmip.2020.100058","DOIUrl":"https://doi.org/10.1016/j.pmip.2020.100058","url":null,"abstract":"<div><h3>Background</h3><p><span><span>Obsessive-Compulsive Disorder (OCD) has a complex genetic component and may be preceded by environmental stressors. The spindle and </span>kinetochore associated complex subunit 2 (</span><em>SKA2</em>)<!--> <span>gene interacts with the glucocorticoid receptor<span> and is implicated in mediating hypothalamic–pituitary-adrenal (HPA) axis function but has yet to be examined in OCD. We hypothesized that genetic and epigenetic variation of </span></span><em>SKA2</em> may be involved in OCD disease risk and symptom severity.</p></div><div><h3>Methods</h3><p>OCD patients (n = 54) were rated for disease severity using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Genotyping of <em>SKA2</em><span><span><span> rs7208505 was performed using Taqman TM, while DNA methylation<span><span> levels were quantified using bisulfite </span>pyrosequencing. OCD genotype frequencies were compared to the general population (n = 379, </span></span>1000 Genomes Project<span> Consortium) using Pearson’s chi-square test. The relationships among the rs7208505 variant, methylation density, and symptom severity were modeled using </span></span>linear regression.</span></p></div><div><h3>Results</h3><p>Genotype distributions significantly differed between OCD patients and the 1000 Genomes sample (χ² (2, n = 433) = 8.66, p = 0.013). The odds of having OCD was 1.66 times more likely for individuals carrying a C allele (OR 1.66 [95% CI: 1.09–2.55]; p = 0 0.02). Specifically, the odds of having the CC genotype was 2.58 times more likely for OCD patients (OR 2.58 [95% CI: 1.23–5.23]; p = 0.007). When examining symptom severity there was no effect of genotype (p &gt; 0.05). Finally, epigenetic variation was not significantly associated with symptom severity in our statistical models.</p></div><div><h3>Conclusions</h3><p>These results provide preliminary evidence that <em>SKA2</em> genetic variation may be associated with OCD disease status, while no association was detected when examining symptom severity, or methylation density at this locus. The rs7208505 minor allele occurs more frequently in OCD patients than in the general population, suggesting that there is merit in pursing further studies of this marker in larger sample sizes.</p></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"21 ","pages":"Article 100058"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91617332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative treatment-subgroup interactions in the antidepressant treatment of major depression: Application of QUINT to individual participant data from seven placebo-controlled randomized controlled trials","authors":"Kazushi Maruo ,&nbsp;Toshi A. Furukawa ,&nbsp;Hisashi Noma ,&nbsp;Hissei Imai ,&nbsp;Kazutaka Ikeda ,&nbsp;Shigeto Yamawaki","doi":"10.1016/j.pmip.2019.100054","DOIUrl":"https://doi.org/10.1016/j.pmip.2019.100054","url":null,"abstract":"<div><h3>Background</h3><p>Personalized medicine in depression has been much discussed but has seen little success so far. We applied Qualitative interaction trees (QUINT), a recently developed method that focuses on qualitative, rather than quantitative, treatment-subgroup interactions, to identify subgroups of patients for whom efficacy of antidepressants may vary.</p></div><div><h3>Methods</h3><p>We had direct access to four placebo-controlled randomized trials of antidepressants and remote access to three trials. We applied QUINT to the first half of the first four trials (the derivation set, n = 704). We used 15 baseline demographic or clinical variables as candidate effect modifiers. We then tested the temporal validity of the obtained subgroups with the second half of the first four trials (the temporal validation set, n = 778), and their external validity with the remaining three trials (the external validation set, n = 1321).</p></div><div><h3>Results</h3><p><span>“Years since onset” and “Sex” were retained in the final model. The antidepressants were significantly inferior to placebo among men with recent onset of depression, not significantly so among women with recent onset, but was significantly superior among men and women whose onset of depression was one or more years before </span>treatment commencement. The ordering of the subgroups in terms of antidepressant efficacy was replicated in the temporal validation set but was poorly replicated in the external validation set.</p></div><div><h3>Conclusion</h3><p>Time since illness onset and sex may be important effect modifiers. However, the models need external validation. To advance personalized medicine in psychiatry, concerted efforts are called for to obtain larger datasets with common key measurements.</p></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"21 ","pages":"Article 100054"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.pmip.2019.100054","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91617363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open-label pilot study of psychiatric pharmacogenetic testing in an adult psychiatric inpatient population","authors":"Christopher D. King ,&nbsp;Agustin G. Yip ,&nbsp;Ying A. Cao ,&nbsp;Fernando Rodriguez-Villa ,&nbsp;David S. Krause ,&nbsp;Daniel Dowd ,&nbsp;Kerry J. Ressler","doi":"10.1016/j.pmip.2020.100060","DOIUrl":"https://doi.org/10.1016/j.pmip.2020.100060","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Treatment outcomes for depression and anxiety disorders remain suboptimal. Pharmacogenetic-guided medication treatment may be one way to improve outcomes. However, feasibility of </span>pharmacogenetic testing in inpatient psychiatric settings has not been explored. This pilot study investigated the feasibility of collection and potential efficacy of pharmacogenetic testing three months after psychiatric hospitalization for severe depression and anxiety-related symptoms.</p></div><div><h3>Methods</h3><p>Participants (n = 75) in this open-labeled study were inpatients on a short-term acute care unit for severe depression and anxiety. Participants were assigned to control and experimental conditions. The experimental group completed a psychiatric pharmacogenetic assay while inpatient. Results were returned prior to discharge, allowing prescribers to adjust medication regimens as clinically indicated. The control group received pharmacogenetic results three months later. At admission and three months later, participants completed self-report measures to address psychiatric symptoms, quality of life, and satisfaction with the pharmacogenetic assay.</p></div><div><h3>Results</h3><p>Reductions on primary outcome measures were not significantly different between study groups. The experimental group did not report significantly greater reductions than the control group on primary study outcomes of anxiety, depression, frequency of medication changes following discharge or on some secondary study measures. Participants in the experimental group did report significantly greater reductions than controls on quality of life impairment (<em>X²</em> = 8.51, <em>p=</em>.004) after corrections for multiple comparisons.</p></div><div><h3>Conclusions</h3><p>This open-label pilot study provides preliminary support for the feasibility of psychiatric pharmacogenetic testing in an inpatient setting. Future studies should investigate psychiatric pharmacogenetic testing efficacy in larger inpatient samples and account for medication changes resulting directly from test results.</p></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"21 ","pages":"Article 100060"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91617364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose lithium impact in an addiction treatment setting","authors":"Sudhir Gadh","doi":"10.1016/j.pmip.2020.100059","DOIUrl":"https://doi.org/10.1016/j.pmip.2020.100059","url":null,"abstract":"<div><h3>Background</h3><p>This study is to assess the effectiveness of low-dose lithium Carbonate (150 mg) augmentation or as a substitute for synthetic antidepressants and antianxiety medications in a residential addiction treatment center. The hypothesis being that adding or using low-dose lithium will improve treatment outcomes on multiple measurable levels.</p></div><div><h3>Results</h3><p>Marked effects in terms of patient medication usage, safety, and progress along with clinic functioning were recorded. Average opiate MAT dose was reduced by 50%, benzodiazepine usage reduced by 99%, atypical antipsychotics down by 70%, polypharmacy lowered by 79%, and smoking cessation participation increased by 300%. Within the clinic, average census increased by 10%, retention of patients improved by 25%, employment rate and readiness both doubled. Overall program completion improved by 20% while the completion rate of those who took low-dose lithium improved by almost 100%. There were no significant changes in standard lab measurements indicating safety of low-dose lithium usage.</p></div><div><h3>Conclusion</h3><p>The introduction of low-dose Lithium in an addiction treatment setting where trauma, untreated ADHD and medical conditions are common was useful in helping patients achieve and maintain progress in their lives. If further randomized studies confirm what we have seen, the implications could be paradigm shifting.</p></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"21 ","pages":"Article 100059"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.pmip.2020.100059","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91656474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocolization as a method of addressing heterogeneity in electroconvulsive therapy delivery","authors":"Jordan Stone ,&nbsp;Samuel Collier","doi":"10.1016/j.pmip.2020.100055","DOIUrl":"https://doi.org/10.1016/j.pmip.2020.100055","url":null,"abstract":"<div><p>Electroconvulsive therapy<span> (ECT) has proven efficacy in the treatment of multiple psychiatric disorders, and there is growing evidence for its use as a maintenance treatment. However, there is substantial heterogeneity in ECT administration with respect to treatment parameters plus frequency of continuation and maintenance therapy. This renders confusion to clinicians seeking best practice guidelines as well as patients who transfer between institutions with different ECT practices. Protocolization is a potential method to address these discrepancies leading to more homogeneous treatment and a narrower standard of care. An ECT treatment protocol influenced by contemporary evidence and guidelines is presented. Strengths and weaknesses of the protocol are discussed.</span></p></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"21 ","pages":"Article 100055"},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91617343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anxiolytic benefits of compounded Atenolol–Scopolamine in eight patients in psychiatry","authors":"Ashley B. Benjamin ,&nbsp;Thomas P. Dooley","doi":"10.1016/j.pmip.2019.10.001","DOIUrl":"10.1016/j.pmip.2019.10.001","url":null,"abstract":"<div><p><span><span>There is an unmet medical need for fast-acting, effective, non-dependent and non-addicting anxiolytic treatments, in lieu of </span>benzodiazepines<span>. Compounded tablets of PanX® Atenolol–Scopolamine HBr were administered orally in eight patients with complex diagnoses receiving residential psychiatric care for acute anxiety and/or other conditions. Three of the eight patients were being treated for substance abuse. The primary endpoint was a reduction in the severity of “State” anxiety symptoms using the Beck Anxiety Instrument (BAI-S), prior to drug administration and one hour and/or approximately four hours after oral administration. Six of the eight patients were responders with a perceived calming effect and substantial reductions in their BAI-S scores. The mean of the BAI-S scores for all eight patients, including two deemed as non-responders, were 15.9 at baseline pre-treatment, 8.5 at 1 h post-treatment, and 4.1 at approximately 4 h. The mean of the heart rate was reduced from 93.6 bpm pre-treatment to 77.0 bpm at 1 h post-treatment and 79.7 bpm at 4–5 h. The mean of the </span></span>blood pressure decreased<span><span> by 10.1 mmHg systolic and 5.3 mmHg diastolic at 1 h post-treatment and even greater at 4–5 h. The reductions in heart rate and blood pressure are consistent with the effects of the beta blocker<span> Atenolol. The drug combination was well tolerated in all patients with minor side effects in some, i.e., </span></span>dry mouth<span> and mild sleepiness (mild sedation). The beneficial reduction in anxiety symptoms was perceived within 15–60 min and persisted for up to 8 h.</span></span></p></div>","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"19 ","pages":"Article 100051"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.pmip.2019.10.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114987366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical implementation of precision psychiatry","authors":"Tali M. Ball,&nbsp;Agnieszka Kalinowski,&nbsp;Leanne M. Williams","doi":"10.1016/j.pmip.2019.05.003","DOIUrl":"10.1016/j.pmip.2019.05.003","url":null,"abstract":"","PeriodicalId":19837,"journal":{"name":"Personalized Medicine in Psychiatry","volume":"19 ","pages":"Article 100046"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.pmip.2019.05.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127363633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}