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C.01.05 Personalised medicine: a psychopharmacological perspective
S752
C.02. Optimizing care for patient-centred outcomes in schizophrenia
C.01.05 Personalised medicine: a psychopharmacological perspective D. Stein1 ° 1 University of Cape Town, Department of Psychiatry and Mental Health Observatory 7925, Cape Town, South Africa Previously, psychiatric drugs have been discovered serendipitously, with clinicians having limited information about mechanisms of action (MoAs) and with knowledge of specific benefits only emerging long after approval. In the future, advances in pharmaceutical discovery, as well as in disease mechanisms, may provide a shorter path towards using psychotropic agents in a more selective way, so achieving personalised medicine in psychiatry. Here we review current perspectives on achievements in this field and define areas for improvement. There is a wealth of information related to recently approved antidepressant agents, which has either been made generally available at the time of approval or relatively soon after from a range of sources. Firstly, large pivotal randomised controlled trials have been undertaken. Secondly, significant knowledge about the MoA may have been garnered from laboratory and human studies. Thirdly, there may be data that link the underlying MoA with the clinical benefits of the agent. At the same time, barriers remain before personalised medicine is a reality in psychiatry. Although approaches such as The Research Domain Criteria have been initiated, drug approvals are based on the heterogeneous Diagnostic and Statistical Manual of Mental Disorders criteria for diagnosis. Moreover, although biological psychiatry and the human genome project have emphasised inter-individual variation, most work on biomarkers and pharmacogenomics has not yet crossed from the laboratory into the clinic. There is also an ongoing need for data on the relationship between the MoA and specific benefits of psychotropics for particular groups. Disclosure statement: In the past 3 years, Dr Stein has received research grants and/or consultancy honoraria from AMBRF, Biocodex, Cipla, Lundbeck, National Responsible Gambling Foundation, Novartis, Servier, and Sun.
C.01.06 Cognitive dysfunction in depression: characteristics and burden B. Baune1 ° 1 University of Adelaide, Discipline of Psychiatry, Adelaide, Australia Clinical depression is often associated with significant impairments in multiple domains of neurocognitive function during the acute episode and persists in one-third of patients after clinical recovery of typical depressive symptoms. Subgroups of patients show neurocognitive deficits up to 2 years after an acute mood disorder episode. Research suggests that ongoing cognitive impairment may contribute to the functional impairment frequently observed in patients with episodic and relapsing depression. Specifically, in a significant number of patients, poor reintegration at work occurs after a depressive episode. Moreover, a close association between cognitive dysfunction, reduced general function, productivity and employment status has been reported. This presentation will provide an overview of this clinically relevant area by characterising the clinical significance of cognitive dysfunction in depression, outlining its impact on patient
function and discussing treatment opportunities that target cognitive domains. In addition, since depression is frequently characterised by an episodic nature, cognitive function during acute symptoms and remission will be explored. Other clinical characteristics, such as the relationship between diagnosis (bipolar and unipolar depression) and cognitive function, will also be briefly reviewed. Although increasing age is frequently associated with poor cognitive function, studies indicate that even young patients suffering from depression may already be affected by poorer cognitive function. The clinical relevance of cognitive dysfunction in depression is highlighted by the frequently observed general, social and occupational functional impairments in patients with mood disorders. Disclosure statement: Professor Baune is a member of advisory boards and/or has given presentations for the following companies: AstraZeneca, Lundbeck, Pfizer, Servier, Bristol-Myers Squibb and Wyeth. Professor Baune receives funding from the National Health and Medical Research Council (NHMRC), Australia.
C.02. Optimizing care for patient-centred outcomes in schizophrenia C.02.01 Efficacy and tolerability of antipsychotic treatment J. Peuskens1 ° 1 UPC KU Leuven, Universitair Psychiatrisch Centrum KU Leuven, Kortenberg, Belgium Schizophrenia is a lifelong illness requiring long-term treatment. The aims of pharmacological treatment are to control acute symptoms and improve outcomes such as patient functioning and quality of life [1]. Both first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) are effective in addressing positive symptoms of schizophrenia while negative symptoms and cognitive impairment remain critical unmet treatment needs. As a treatment class, FGAs are associated with more extrapyramidal motor side effects and tardive dyskinesia than SGAs, whereas SGAs are associated with more weight gain and cardiometabolic adverse effects [2]. However, SGAs do not represent a homogenous class of drugs and certain side effects cannot be considered common for the whole group of SGAs [3]. Selection of antipsychotic medications should be based on short-term goals as well as long-term objectives of maintaining symptomatic remission, supporting psychosocial integration and improving quality of life through a balance of effective symptom control and adequate tolerability. Therefore, assessment of the long-term safety and tolerability of antipsychotics is particularly important when initiating therapy. Recent large randomized controlled clinical trials (RCTs) and meta-analyses have produced inconsistent findings concerning the comparative efficacy and tolerability of antipsychotic treatments [2,3]. However, due to their design, RCTs can favour enrolment of highly adherent patients with lower illness severity compared with those routinely seen in practice. Suggesting careful analysis of methodologies and data interpretation may be required when considering treatment options. For each patient, a treatment plan must be formulated and implemented taking into account past and current treatments and response to them.
C.02. Optimizing care for patient-centred outcomes in schizophrenia
C.01.05 Personalised medicine: a psychopharmacological perspective D. Stein1 ° 1 University of Cape Town, Department of Psychiatry and Mental Health Observatory 7925, Cape Town, South Africa Previously, psychiatric drugs have been discovered serendipitously, with clinicians having limited information about mechanisms of action (MoAs) and with knowledge of specific benefits only emerging long after approval. In the future, advances in pharmaceutical discovery, as well as in disease mechanisms, may provide a shorter path towards using psychotropic agents in a more selective way, so achieving personalised medicine in psychiatry. Here we review current perspectives on achievements in this field and define areas for improvement. There is a wealth of information related to recently approved antidepressant agents, which has either been made generally available at the time of approval or relatively soon after from a range of sources. Firstly, large pivotal randomised controlled trials have been undertaken. Secondly, significant knowledge about the MoA may have been garnered from laboratory and human studies. Thirdly, there may be data that link the underlying MoA with the clinical benefits of the agent. At the same time, barriers remain before personalised medicine is a reality in psychiatry. Although approaches such as The Research Domain Criteria have been initiated, drug approvals are based on the heterogeneous Diagnostic and Statistical Manual of Mental Disorders criteria for diagnosis. Moreover, although biological psychiatry and the human genome project have emphasised inter-individual variation, most work on biomarkers and pharmacogenomics has not yet crossed from the laboratory into the clinic. There is also an ongoing need for data on the relationship between the MoA and specific benefits of psychotropics for particular groups. Disclosure statement: In the past 3 years, Dr Stein has received research grants and/or consultancy honoraria from AMBRF, Biocodex, Cipla, Lundbeck, National Responsible Gambling Foundation, Novartis, Servier, and Sun.
C.01.06 Cognitive dysfunction in depression: characteristics and burden B. Baune1 ° 1 University of Adelaide, Discipline of Psychiatry, Adelaide, Australia Clinical depression is often associated with significant impairments in multiple domains of neurocognitive function during the acute episode and persists in one-third of patients after clinical recovery of typical depressive symptoms. Subgroups of patients show neurocognitive deficits up to 2 years after an acute mood disorder episode. Research suggests that ongoing cognitive impairment may contribute to the functional impairment frequently observed in patients with episodic and relapsing depression. Specifically, in a significant number of patients, poor reintegration at work occurs after a depressive episode. Moreover, a close association between cognitive dysfunction, reduced general function, productivity and employment status has been reported. This presentation will provide an overview of this clinically relevant area by characterising the clinical significance of cognitive dysfunction in depression, outlining its impact on patient
function and discussing treatment opportunities that target cognitive domains. In addition, since depression is frequently characterised by an episodic nature, cognitive function during acute symptoms and remission will be explored. Other clinical characteristics, such as the relationship between diagnosis (bipolar and unipolar depression) and cognitive function, will also be briefly reviewed. Although increasing age is frequently associated with poor cognitive function, studies indicate that even young patients suffering from depression may already be affected by poorer cognitive function. The clinical relevance of cognitive dysfunction in depression is highlighted by the frequently observed general, social and occupational functional impairments in patients with mood disorders. Disclosure statement: Professor Baune is a member of advisory boards and/or has given presentations for the following companies: AstraZeneca, Lundbeck, Pfizer, Servier, Bristol-Myers Squibb and Wyeth. Professor Baune receives funding from the National Health and Medical Research Council (NHMRC), Australia.
C.02. Optimizing care for patient-centred outcomes in schizophrenia C.02.01 Efficacy and tolerability of antipsychotic treatment J. Peuskens1 ° 1 UPC KU Leuven, Universitair Psychiatrisch Centrum KU Leuven, Kortenberg, Belgium Schizophrenia is a lifelong illness requiring long-term treatment. The aims of pharmacological treatment are to control acute symptoms and improve outcomes such as patient functioning and quality of life [1]. Both first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) are effective in addressing positive symptoms of schizophrenia while negative symptoms and cognitive impairment remain critical unmet treatment needs. As a treatment class, FGAs are associated with more extrapyramidal motor side effects and tardive dyskinesia than SGAs, whereas SGAs are associated with more weight gain and cardiometabolic adverse effects [2]. However, SGAs do not represent a homogenous class of drugs and certain side effects cannot be considered common for the whole group of SGAs [3]. Selection of antipsychotic medications should be based on short-term goals as well as long-term objectives of maintaining symptomatic remission, supporting psychosocial integration and improving quality of life through a balance of effective symptom control and adequate tolerability. Therefore, assessment of the long-term safety and tolerability of antipsychotics is particularly important when initiating therapy. Recent large randomized controlled clinical trials (RCTs) and meta-analyses have produced inconsistent findings concerning the comparative efficacy and tolerability of antipsychotic treatments [2,3]. However, due to their design, RCTs can favour enrolment of highly adherent patients with lower illness severity compared with those routinely seen in practice. Suggesting careful analysis of methodologies and data interpretation may be required when considering treatment options. For each patient, a treatment plan must be formulated and implemented taking into account past and current treatments and response to them.