Genetic Testing in Psychiatry:
Pharmacogenomics in Psychiatry: From CYPs to Interpretation in Clinical Practice
Lisa Brown, PhD
(45 minutes)
Overview:
In this presentation, Dr. Brown will give an introduction to the basics of psychiatric pharmacogenetics, as well as discuss how to interpret and apply results in clinical practice with specific genes such as CYP450, UGT, SLC6A4, and HTR2A.
Learning Objectives:
- Define and differentiate the terms pharmacokinetic, pharmacodynamic, and immunogenic when it comes to types of genes
- Summarize how to interpret genotype and phenotype information in the context of medications.
- List three clinically actionable gene-drug interactions for the gene, 2D6.
Warriors Versus Worriers: The Role of COMT Gene Variants in ADHD, Anxiety, and Bipolar Disorder
Muneer Ali, MD
(60 minutes)
Overview:
In this presentation Dr. Ali will review the existing literature on COMT gene variants and discuss how understanding this pharmacodynamic gene can better inform clinical decision-making. He will further explain how COMT variants may be interpreted in the context of various patient presentations, including in ADHD with the use of stimulant medication, as well as the management of Anxiety and Bipolar disorders.
Learning Objectives:
- Describe the normal role of the COMT enzyme.
- Summarize the existing literature regarding COMT gene variants.
- Compare the different COMT gene variants and how they may influence the prescribing of stimulant medications.
Brain-Gut Axis Dysfunction and Psychiatric Comorbidities: A Pharmacogenomics Perspective
Kelly Heim, PhD
(60 minutes)
Overview:
Functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome (IBS) and functional dyspepsia (FD), are complex conditions involving brain-gut axis dysfunction and psychiatric comorbidities. Interdisciplinary deployment of psychotropic agents, behavioral therapy and nutritional support leads to better outcomes than conventional monotherapies in gastroenterology. Genetic insights into various neurotransmitter systems and drug metabolizing enzymes can inform more personalized drug and nutrient therapies for these complex conditions.
Learning Objectives:
- Discuss the common neurotransmitter systems involved in the pathophysiology of anxiety, depression, and FGIDs
- List five genetic polymorphisms that influence clinical response to central and enteric neuromodulators
- List three genetic polymorphisms that modify metabolism and pharmacokinetics of drugs used to treat these conditions
Methylation Genetics: Understanding the Role of Folate, B12, and SAMe
James Greenblatt, MD
(60 minutes)
Overview:
Methylation reactions play a critical role in numerous biochemical pathways that modulate neurologic homeostasis. Through their influences on neurotransmitter production, the synthesis and/or degradation of proinflammatory amino acids, and genetic expression, these reactions are the keystones in many biological processes that influence brain function – and, by extension, cognition and mood. Unfortunately, mainstream psychiatric paradigms tend to overlook the role that methylation reactions play in the pathogenesis and entrenchment of psychiatric disorders, despite the fact that research has identified robust correlations between abnormal methylation and mental illness. In this presentation, Dr. Greenblatt will pull the curtain back on key genetic variants influencing methylation reactions, as well as some of the most significant nutritional ‘players’ in endogenous methylation cycles: vitamin B12, folate (vitamin B9), and S-adenosyl methionine (SAMe). He will also discuss common genetic polymorphisms of the MTHFR gene, as well as implications of MTHFR variants and compromised folate metabolism on mental health, with a special focus on ADHD, substance use disorders, and depression.
Learning Objectives:
- Discuss how to use genetic testing in practice to inform treatment decisions and intervention protocols for mental illness
- Describe one protocol for folate, vitamin B12, and/or SAM-e supplementation
- Explain the relationships linking folate, vitamin B12, and SAMe and the implications of deficiencies of each of these compounds for mental health
Red Lights and Red Herrings: Cases in Applied Pharmacogenomics
Boadie Dunlop, MD, MS
(60 minutes)
Overview:
This presentation will review how to discuss results of pharmacogenomics testing with patients and present several cases that exemplify common issues that arise in its clinical application. Cases will demonstrate examples of when pharmacogenomic testing enhanced patient care, as well as examples where testing could lead the prescriber to make non-therapeutic changes to drug regimens.
Learning Objectives:
- Describe how to engage patients in a shared decision-making model about whether to order pharmacogenomic testing.
- List three of the genes with the strongest evidence base supporting their application in pharmacological decision-making.
- Explain how to weigh pharmacogenomic information versus other clinical information in making prescribing decisions.
