{"id":14421,"date":"2011-10-06T23:43:19","date_gmt":"2011-10-07T03:43:19","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=14421"},"modified":"2011-10-07T00:45:41","modified_gmt":"2011-10-07T04:45:41","slug":"warned","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/10\/06\/warned\/","title":{"rendered":"warned…"},"content":{"rendered":"\n

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<\/a>It’s hard not to be skeptical about new scientific developments in matters psychiatric after the last several decades of confusion and misinformation. SSRIs, SNRIs, Mood Stabilizers, Atypical Antipsychotics – each came with inflated or distorted claims of efficacy and illusions of safety that evaporated with widespread usage. While that’s an expected danger in any medical advance, the widespread collusion of academic and organized psychiatry with the pharmaceutical industry upset the balance between restraint and innovation, leaving patients and practitioners alike fumbling in the dark on a what started out to be a bright, shiny day.<\/p>\n

Comes now personalized medicine<\/em> – the name given to the treatment possibilities hypothetically opened up now that genetic testing is available. A number of psychiatric disorders have long been thought to be inherited, though the familial associations are statistical rather than Mendelian and likely represent a level of genetic complexity yet undeciphered – Schizophrenia, Manic-Depressive Illness, Attention Deficit Disorder, etc. So the exciting genomic technology available offers a new avenue for that research, but that’s not what personalized medicine<\/em> means. Says Wikipedia<\/font><\/strong><\/a>: <\/div>\n
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Personalized medicine is a medical model emphasizing in general the customization of healthcare, with all decisions and practices being tailored to individual patients in whatever ways possible. Recently, this has mainly involved the systematic use of genetic or other information about an individual patient to select or optimize that patient’s preventative and therapeutic care.<\/sup><\/div>\n<\/blockquote>\n
The classical example has to do with the Cytochrome P450<\/font><\/strong><\/a> family of enzymes that moderate drug metabolism:<\/div>\n
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Many drugs may increase or decrease the activity of various CYP isozymes either by inducing<\/font><\/strong> the biosynthesis of an isozyme (enzyme induction) or by directly inhibiting<\/font><\/strong> the activity of the CYP (enzyme inhibition<\/span>). This is a major source of adverse drug interactions, since changes in CYP enzyme activity may affect the metabolism and clearance<\/span> of various drugs. For example, if one drug inhibits the CYP-mediated metabolism of another drug, the second drug may accumulate within the body to toxic levels. Hence, these drug interactions may necessitate dosage adjustments or choosing drugs that do not interact with the CYP system. Such drug interactions are especially important to take into account when using drugs of vital importance to the patient, drugs with important side-effects and drugs with small therapeutic windows, but any drug may be subject to an altered plasma concentration due to altered drug metabolism.<\/sup><\/div>\n<\/blockquote>\n
The list of drugs<\/font><\/strong><\/a><\/u> affected is impressive [including many of the psychopharmacologic medications] and clarifies a lot about drug reactions and toxicities, but even that’s not where all the excitement about personalized medicine<\/em> in psychiatry centers. It’s in the area of treatment choice. <\/div>\n

Matters genetic are not so simple as they were in high school biology. Genes encode proteins – which about covers everything there is, so the breakthrough of sequencing the Human Genome only opens a new door but says little about what’s on the other side. The possibilities are both exciting and daunting – so genomics, proteomics, and metabolomics are quite the rage but remain obscure. In psychiatry, the focus is on using genotyping to predict drug response. Such a hypothesis requires skipping an ocean of scientific steps, but that never stopped anyone. There are two approaches – one is to look at genes that might have some effect on known mechanisms of a medication [like serotonin metabolism] and compare the genotypes of responders to various drugs. Another approach is to measure as many things as humanly possible and look for any associations with drug response – going "fishing." Both methods are underway in multiple foci as we speak.<\/p>\n

Other than a new vocabulary, it all has a familiar ring. Personalized medicine<\/em> has become the new future, the new leading edge in psychiatric research. What’s familiar? The voices for one thing seem to come from a familiar chorus. Last week we listened to Dr. Jeffrey Lieberman<\/font><\/strong> talk about the topic. And here’s a sampling of some other voices: <\/div>\n
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    NIMH STUDY<\/font><\/strong><\/u><\/a>:<\/div>\n