Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from...
Transcript of Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from...
![Page 1: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/1.jpg)
Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes
presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th September 2014
![Page 2: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/2.jpg)
Personalized Psychiatry:
is it really something new?
![Page 3: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/3.jpg)
![Page 4: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/4.jpg)
Panic patient type A
T-a
Panic patient type C
T-b
Panic patient type B
T-c
![Page 5: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/5.jpg)
Personalized Psychiatrist:
is this enough?
![Page 6: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/6.jpg)
Personalized Psychiatrist approach: Biases…….
WYSIWYG: What You See is What You Get
What You See Is All You Get !
can you see genes? can you see heart rate variability? can you see HPA axis function? ……………
![Page 7: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/7.jpg)
Personalized Psychiatrist approach: Biases…….
“Personal” Models of Mental Disorders
Education Experiences Personality Age Sex …………….
Patient fitting
our model
+
Patient not fitting our model
We See What We Want to See
![Page 8: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/8.jpg)
Personalized Psychiatry as a Science will help us to:
To move from the science of “mean ideal patient” to the science of “real life patient” To become better Personalized Psychiatrists: - overcoming our personal biases - including “hidden” information in our thinking - opening our mind to ideas of others
![Page 9: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/9.jpg)
![Page 10: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/10.jpg)
Panic Perna Personalized Psychiatry (P4)
1. Respiratory, Cardiac, Vestibular Patterns are those specific for Perna’s True Panic Patients 2. Cardiorespiratory patients respond better to paroxetine and clomipramine 3. Patients with otovestibular symptoms respond better to sertraline 4. Clomipramine works on dyspnea panic patients 5. Fluovamine does not work in panic patients 6. Cardiorespiratory patients respond quicker than depersonalization patients 7. Paroxetine & SSRIs are protective on cardiovascular system 8. CO2 hypersensitivity is an endophenotype of true panic patients 9. …… 10..….
![Page 11: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/11.jpg)
Personalized Psychiatry & Panic Disorder:
a Systematic Review of Predictors of Efficacy of Antipanic treatments
![Page 12: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/12.jpg)
(“panic disorder”[TIAB] AND (“predict*” OR (("treatment*" OR “therapy” OR “therapies” OR “pharmacotherapy” OR “psychotherapy") AND “response”) OR “pharmacogen*” OR “longitudinal” OR “artificial neural network” OR “artificial neural networks” OR “support vector machine” OR “support vector machines”
Key words in PubMed database (up to 15 August)
References obtained: 1167 References selected: 171
![Page 13: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/13.jpg)
Not predictors of response to treatment: 1. Agoraphobia (both drugs and CBT)(9/9 studies) 2. Diagnosis of Depression (both drugs and CBT (5/6 studies) 3. Duration of illness (both drugs and CBT) (11/11 studies) 4. Gender (both drugs and CBT) (19/22 studies) 5. Age (both drugs and CBT) (16/19 studies)
Discordant data: 1. Panic Severity
2. Anxiety Severity (discordant for drugs, negative for CBT)
3. Depressive symptomatology
4. Respiratory subtype
![Page 14: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/14.jpg)
Predictors of response to treatment: 1. Blood levels of Antipanic drugs (9/10 studies)
1. Early response to treatment (both drugs and CBT) (5/5 studies)
1. Personality Disorders comorbidity (both drugs and CBT
(8/9 studies)
![Page 15: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/15.jpg)
Personalized Psychiatry & Panic Disorder:
Genetics
![Page 16: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/16.jpg)
![Page 17: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/17.jpg)
![Page 18: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/18.jpg)
![Page 19: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/19.jpg)
![Page 20: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/20.jpg)
![Page 21: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/21.jpg)
![Page 22: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/22.jpg)
![Page 23: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/23.jpg)
![Page 24: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/24.jpg)
![Page 25: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/25.jpg)
![Page 26: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/26.jpg)
![Page 27: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/27.jpg)
![Page 28: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/28.jpg)
Personalized Psychiatry & Panic Disorder:
Neuroimaging
![Page 29: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/29.jpg)
![Page 30: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/30.jpg)
![Page 31: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/31.jpg)
Greater activation in cortico-limbic circuitry predicts better CBT response
![Page 32: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/32.jpg)
Personalized Psychiatry & Panic Disorder:
Respiration
![Page 33: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/33.jpg)
![Page 34: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/34.jpg)
![Page 35: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/35.jpg)
![Page 36: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/36.jpg)
Paroxetine Sertraline
Clinical outcome after 1 month of treatment > Fluvoxamine
![Page 37: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/37.jpg)
pCO2 response to CBT or ACT
![Page 38: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/38.jpg)
![Page 39: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/39.jpg)
![Page 40: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/40.jpg)
![Page 41: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/41.jpg)
Personalized Psychiatry
Studies
Ideas for new predictors Challeging personal models
Better Personalized Psychiatrist !
![Page 42: Personalized Psychiatry & Panic Disorder: from …...Personalized Psychiatry & Panic Disorder: from Genetics to Endophenotypes presented by. Giampaolo Perna, MD, PhD WPA Madrid, 16th](https://reader035.fdocuments.net/reader035/viewer/2022081400/5f0af4587e708231d42e28b4/html5/thumbnails/42.jpg)
The future…..?
These are AI systems doesn’t work according to predetermined general decision algorithms and rules (as guidelines do for the “average” patients). Instead they can provide personalized predictions and suggest clinical decisions tailored on the individual characteristics of each individual, joining the ability to handle the complexity of real clinical cases and the rigor of algorithms.
The techniques are able to learn and modellize them starting from a certain amount of so-called training cases.
Machine Learning: Supervised Artificial Neural Networks