Psychiatric Drug Development: Why So Slow?

Hello. This is Dr. Jeffrey Lieberman of Columbia University talking to you today for Medscape. I wanted to talk about a series of developments that have occurred that are likely to affect the pace of new drug development, particularly in the area of psychotropic drugs.

I think everybody who practices clinical psychiatry knows that the rate of real mechanistic innovation for drugs in all the major drug classes — whether they are antipsychotics, anticonvulsant mood stabilizers, antidepressants, or anxiolytics –has been painfully slow. In fact, currently in this 21st century we are still using drugs that work by essentially the same mechanisms of action [MOA] as those developed as original prototypes for these classes of medications back in the 50s and the 60s. For antipsychotic drugs the MOA is still D2 antagonists. For mood stabilizers we have lithium and the anticonvulsant medications. For antidepressants we have drugs that inhibit the uptake of catecholamine and indolamine neurotransmitters. For anxiolytics we have essentially antidepressant medications and benzodiazepine receptor agonists……

By Jeffrey A. Lieberman, MD

Submitted by Anna

Metabolic Abnormalities With Antipsychotics: A Management Update

Hello. This is Dr. Jeffrey Lieberman of Columbia University [New York, NY] talking to you for Medscape. Today I would like to address the topic of drug-induced weight gain and metabolic disturbances, specifically as they relate to antipsychotic drugs.

It is well known that psychotropic drugs, in general — and antipsychotic drugs, in particular — have as one of their side-effect liabilities the potential to cause weight increase and disturbances in metabolic parameters, particularly involving glucose and lipid metabolism. These are not part and partial to the same phenomenon — the same pathophysiologic effect — but seem to be overlapping effects. We don’t understand, at this point, the reason why psychotropic drugs — and particularly antipsychotic drugs — do this, and we don’t know the way in which the potential to cause weight gain vs hyperglycemia vs hyperlipidemia relates to each other. This remains to be understood, but we do know that these occur, and often co-occur together…..

By Jeffrey A Lieberman, MD

Submitted by Anna

Portland police chief fired following settlement

Portland Mayor Sam Adams fired the city’s police chief Wednesday, a day after the city agreed to pay $1.6 million to settle a lawsuit over the death of a mentally ill man in police custody.

By William McCall
The Associated Press

Submitted by Anna

Schizophrenia Drugs Raise the Volume of a Key Signaling System in the Brain

All the major groups of medications for schizophrenia turn up the volume of a brain signal known to be muted in individuals with this psychiatric disorder — a signal that also can be influenced by diet. “This is the first example of a common but specific molecular effect produced by all antipsychotic drugs in any biological system,” scientists note in the current edition of ACS Chemical Neuroscience.

Story Source: Adapted from materials provided by American Chemical Society, via EurekAlert!, a service of AAAS.

Journal Reference: Weeks et al. Antipsychotic Drugs Activate the C. elegans Akt Pathway via the DAF-2 Insulin/IGF-1 Receptor. ACS Chemical Neuroscience, 2010; 100325110757056 DOI: 10.1021/cn100010p

Submitted by Anna

Schizophrenia: Regular Exercise Guidelines Still Apply

Regular exercise can play an important a role in improving the physical and mental wellbeing of individuals with schizophrenia, according to a review published in The Cochrane Library. Following a systematic review of the most up-to-date research on exercise in schizophrenia, researchers concluded that the current guidelines for exercise should be followed by people with schizophrenia just as they should by the general population.

Source: Adapted from materials provided by Wiley-Blackwell, via EurekAlert!, a service of AAAS.

Journal Reference: Gorczynski P, Faulkner G. Exercise therapy for schizophrenia. Cochrane Database of Systematic Reviews, 2010, Issue 5. Art. No.: CD004412 DOI: 10.1002/14651858.CD004412.pub2

Submitted by Anna

Schizophrenia: A Review of Pharmacologic and Nonpharmacologic Treatments

Patients with mental illness constitute a population that can be challenging for any health care provider, but they offer great opportunities for a pharmacist to make a meaningful contribution. The pharmacist’s role might involve assisting in the selection of medication regimens, managing adverse drug reactions, or facilitating adherence. These interventions can be particularly important for patients with schizophrenia.

Reported by Stacy Eon, PharmD; Jennifer Durham, PharmD
U.S. Pharmacist

Submitted by SARDAA

Genetic test could match mentally ill patients with the best drug

A genetic test that predicts how patients with mental illnesses such as depression and schizophrenia will respond to drugs is to be offered to British doctors, in a step towards a new era of personalised medicine.

The £1,000 procedure, which is already used in several US hospitals, uses individuals’ DNA to assess whether 26 psychiatric drugs — including Prozac and Seroxat — are likely to work or cause side-effects.

It promises to bring significant improvements to the care of patients with psychiatric conditions, at least a third of whom do not currently benefit from the first drug they are prescribed because they cannot tolerate it or it has no effect.

The development highlights the growing potential of genetics to tailor treatment according to patients’ DNA profiles. This practice, known as pharmacogenetics or pharmacogenomics, is expected to transform many branches of medicine over the next decade, helping doctors to select the therapy that works best for a particular patient.

The psychiatric DNA test, known as GeneSightRx, is offered by the US company AssureRx, which plans to introduce it in Europe by the end of the year.

Reported by Mark Henderson, Science Editor
The Times

Source: Francis Collins, The Language of Life; Times database

Submitted by Darrell H

“Born Schizophrenic”: Q & A with Michael and Susan Schofield

“It’s not impossible to live with schizophrenia, but it requires creating an environment of people who are working toward a common goal.”

— Susan Schofield, mother of 7-year-old schizophrenic child January

There are an estimated 2.4 million American adults living with schizophrenia, reports the National Institute of Mental Health Epidemiologic Catchment Area Program. Stereotypically, and incorrectly so, many people associate schizophrenia with split personality disorder. The reality of schizophrenia is that sufferers may experience a range of symptoms including hallucinations, delusions and disorganized thinking. Some may suffer from movement disorders, including repetitive motions or catatonic states. They may have trouble managing daily tasks, problems concentrating and problems with memory.

Most people suffering from schizophrenia usually develop the disease during adolescence or young adulthood, and pediatric cases are extremely rare — which makes January Schofield, known as Jani, an exceptional child.

Jani was diagnosed with schizophrenia when she was five years old, making her one of the youngest ever to be diagnosed with the illness. We spoke with Jani’s parents, Michael and Susan Schofield, to learn more about Jani, her challenges and her journey.

Reported by Maria Colenso,

Submitted by Anna

Children Bullied At School At High Risk Of Developing Psychotic Symptoms

Children who are bullied at school over several years are up to four times more likely to develop psychotic-like symptoms by the time they reach early adolescence.

Researchers at the University of Warwick found children who suffered physical or emotional bullying were twice as likely to develop psychotic symptoms by early adolescence, compared to children who are not bullied. However, if they experienced sustained bullying over a number of years that risk increases up to four times.

The research team, led by Professor Dieter Wolke, Professor of Developmental Psychology, followed 6,437 children from birth to 13 years.

The children took part in annual face-to-face interviews, psychological and physical tests. Parents were also asked to complete questionnaires about their child’s development. When they reached 13 years of age they were interviewed about experiences of psychotic symptoms in the previous six months.

Psychotic symptoms include hallucinations, delusions such as being spied on or bizarre thoughts such as one’s thoughts are being broadcast.

Professor Wolke said: “Our research shows that being victimised can have serious effects on altering perception of the world, such as hallucinations, delusions or bizarre thoughts where the person’s insight into why this is happening is reduced.”

“This indicates that adverse social relationships with peers is a potent risk factor for developing psychotic symptoms in adolescence and may increase the risk of developing psychosis in adulthood.”

Story Source from materials provided by University of Warwick.

Journal Reference: Schreier et al. Prospective Study of Peer Victimization in Childhood and Psychotic Symptoms in a Nonclinical Population at Age 12 Years. Archives of General Psychiatry, 2009; 66 (5): 527 DOI:10.1001/archgenpsychiatry.2009.23

Submitted by Anna