“Equipoise The Application of Pharmacogenomics in …4/3/2019 1 “Equipoise*” The Application...
Transcript of “Equipoise The Application of Pharmacogenomics in …4/3/2019 1 “Equipoise*” The Application...
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“Equipoise*” The Application of Pharmacogenomics in Clinical Practice
Mary S. Riccelli, PMHNP, B.C. Meliora Direct Health Colorado 8400 East Crescent Parkway Greenwood Village, CO 80111 New York 488 Pawling Ave Troy, NY www.melioradirecthealth.org 720-317-9460
Disclosures
Relevant Financial Relationships:
Receives speakers’ bureau financial compensation from GENOMIND Inc.
Receives honoraria for CE courses and seminars, including this one.
Owner Meliora Direct Health LLC
Mary S. Riccelli, PMHNP, B.C.
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“Change the way you look at things and the things you look at will change.”
Wayne Dyer
Traditional Treatment Strategy
✓Obtain patient history including family history, symptom profile, and past treatment response
✓ Utilize Clinical Practice Guidelines
✓ Use appropriate screening tools
✓ Select diagnosis and treatment
Proposed New Treatment Strategy
✓ Exhaust all evidence-based solutions
✓ Take another history
✓ Reconsider diagnosis
✓ Collect new data!
✓ Pharmacogenomics!
✓ Treat by rebalancing all evidence “equipoise”*
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Why use genetic testing in clinical practice?
✓ Avoid the trial and error approach
✓ Improve compliance with treatment
✓ Take a wider look at all available evidence-“let the brain talk”
✓ Successful interpretation and application generates more referrals from satisfied patients
✓ Fewer phone calls from patients, because they are stable If the brain could talk!
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"There is no reason anyone would want a computer in their home.”
Ken Olsen, founder of Digital Equipment Corporation, 1977
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Genetics is the New Technology in Psychiatry
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Key Questions
Does the test result have any clinical utility?
Will it change or improve my practice?
Will it help my patient?
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It’s Nature and Nurture!!
Epigenetics: the study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself.
GeneticsYour parents did it!
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Reading and Interpreting ResultsPHARMACODYNAMIC GENES
SLC6A4BDNF
Efficacy of SSRIs
5HT2C MC4R
Weight gain
CACNA1CANK3
Neuronal Signaling
COMTADRA2A
Prefrontal and Frontal Cortex Dopamine-Response to Stimulants
DRD2 DOPAMINE Receptors: Response to Antipsychotics
GRIK1OPRM1
Alcoholism and other impulsive/addictive behaviors:Response to Topiramate and Response to Opiates
MTHFR Methylation and Supplements
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Efficacy of SSRIs
Gene: SLC6A4
Efficacy of SSRIs
Gene: SLC6A4
I’ve tried all the SSRIs,-twice!! and
none of them work! Then my doctor added Aripiprizole and Bupropion-it still didn’t work!!! Then the doctor told me-
Try exercise!!!
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Proportionate distributions (%) of SLC6A4 variants in different global populations.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3487694
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Efficacy of SSRIsGENE: BDNF
https://www.ncbi.nlm.nih.gov/pubmed/Role of exercise-induced brain-derived neurotrophic factor production in the regulation of energy
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Weight Gain:Genes: 5HT2C and MC4R
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MTHFR
rhttp://www.mdl-labs.com/providers/tests/mthf
Supplements
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COMT: VALVAL
COMT: MET/MET
MET/MET= anxietyNeed to decreaseDopamine
Aripiprizole/Lurasidone/CariprazineHyper-dopaminergic prefrontal cortexHigh anxietyHyper-focusedHyper-sensitive
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ADRA2A
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CYP 450
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