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NPiSTANBUL Genetic Counseling Centre
PERSONALISED TREATMENT AT NEUROPSYCHIATRY |
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| - Pharmacogenetics - Therapeutic Drug Monitoring (TDM) - Assessment of the risk for an inherited disorder |
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PHARMACOGENETICS |
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| Major depressive disorder, schizophrenia and related disorders are among the greatest causes of disability and death all over the world. These disorders which have many effects on public health are fairly common, chronicle and recurrent. Antidepressants are standard treatment for clinical depression likewise antipsychotics are standard treatment for schizophrenia. Despite the wide variety of drugs, without considering initial psychiatric drug choice, 30-50% of the patient doesn't response to acute treatment. In the case of major psychiatric disorders, need for clinical accomplishment is quite increased. Defining genetic factors that lies under the drug response become one of the most promising research area of molecular biology and genetics. According to the randomized and controlled researches, only 35-45% of patients treated with standard dose of widely used antidepressants could be reached to the premorbid functionality level without any important depression symptom after 6 – 8 weeks. Concerning drug metabolism, wide genetic variety was defined in the genetic modulators of drug effectiveness and drug treatment response. Beside that, it's not possible yet to detect possibility of the drug response of the patient and choose and modify the best drug and dosage via genetic techniques. While developing more faster and effective ways of genetic test, guidance of the pharmacogenetics to whole treatment can be possible after acquired reliable prediction power of clinical results. It seams that this can be possible by using pharmacogenetics accompanied with drug blood level monitoring. |
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THERAPEUTIC DRUG MONITORING (TDM) |
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| During the last three decades, Therapeutic Drug Monitoring (TDM) was defined for many drugs as a branch of clinical chemistry. Today, TDM is coupled with Pharmacogenetic tests. Despite the fact that TDM has obvious benefits for psychiatry, clinical applications have been applied for limited number of patients and cases. For this reason, clinical and scientific organizations published atlases and guidelines in which psychiatric pharmacotherapy is used as a practice for the acute or long term treatment of psychiatric patients. These guidelines published by American Psychiatric Association (2000), World Health Organization ‘World Journal of Biological Psychiatry’ (2001-2003), German Association for Psychiatry and Nervous System Disorders (1998), German Drug Commition of the Medical Association (1997). Algorithms (treatment procedures) that are used in psychiatric pharmacotherapy were defined in these publications, and also the aim of them is to deal with psychopathology, comorbidity existence, sex, age and personal biological factors. |
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| Pharmacogenetics Laboratory at NPİSTANBUL Neuropsychiatry Hospital was founded to monitor drug blood level by TDM (Therapeutic Drug Monitoring) and identify genetic profiles of patients correlated to the drugs that are used. In this laboratory, validated methods were developed for quantitative measurement of risperidone, escitalopram, fluoxetin, paroxetin, mirtazapine, quetiapine, venlafaxine, amisulpiride, olanzapine, carbamazepine and many other drugs by using citrated human plasma. Measurements are made using LC-MS/MS. Desipramine is used as an internal standard solution while the precision and accuracy are in the acceptable range defined by FDA Guidance 2001. This technique is used just for new born check-up in the hospitals of Turkey. This is the first time use of a high tech system for quantitative drug analysis in the clinical routine. The technique that was developed is an appropriate phenotyping procedure for tracing unexpected toxicity during normal rates of the drug dosage. It could detect metabolized drug levels which might be fast or slow, in order to prevent unnecessary drug use. It allows us to detect the patients with gen polymorphism by means of drug blood concentration differences. Additionally, need for genotyping which is a long lasting procedure is decreased. |
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PSYCHIATRIC GENETIC COUNSELING (ASSESSMENT OF THE RISK FOR AN INHERITED DISORDER) |
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| The genetic counseling session will probably last about an hour, and what is covered during the session will be different for each person. But here are some general things that are likely to occur: - A detailed family history will be taken by the counselor. The more information you can gather the better the counselor can study and share the type and pattern of psychiatric conditions that may run in your family. - Using the family history information, the counselor will talk about the likely cause of the illness in your family. Some people are interested in talking about risks for themselves, their children or other family members to develop the condition or related conditions. - Education about the cause and symptoms of the condition(s) - While genetic testing is not yet available for most psychiatric conditions, the genetic counselor will explore with you how likely it is that other family members might become ill. - The genetic counselor may also discuss environmental risk factors in and outside of the home, what to look for in a young person at risk for the condition and when to seek treatment. - The genetic counselor can help you develop strategies for dealing emotionally with the risk in your family and the uncertainty related to whether a family member will or will not become ill. |
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Why see a psychiatric genetic counselor? |
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| If you have a personal or family history of a psychiatric or mental health condition, the psychiatric genetic counselor will help to answer questions you have about the cause of the condition and the chance it can happen again in your family. These types of conditions may include depression, bipolar disorder, schizophrenia and others. If you are pregnant or considering pregnancy, the risk to your children based on your personal or family history of a psychiatric disorder will be discussed. In general, there is no genetic testing offered during psychiatric genetic counseling sessions, but during genetic counseling session you can get information about actual genetic research results. |
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What should I do to prepare for my appointment? |
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| To get the most out of the appointment, try to provide as much information as possible about the psychiatric conditions in your family. Try to find out about: - Your own mental health history and current status - Who in your family has mental health conditions - The names of the condition(s) that run in your family, if known - Ages that people in your family began having symptoms and were diagnosed |
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What will happen during my appointment? |
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| The genetic counseling session will probably last about an hour, and what is covered during the session will be different for each person. But here are some general things that are likely to occur: - A detailed family history will be taken by the counselor. The more information you can gather the better the counselor can study and share the type and pattern of psychiatric conditions that may run in your family. - Using the family history information, the counselor will talk about the likely cause of the illness in your family. Some people are interested in talking about risks for themselves, their children or other family members to develop the condition or related conditions. |
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| NPISTANBUL Neuropsychiatry Hospital | |||||||||||||
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Transcranial Magnetic Stimulation TMS is a procedure in which electrical activity in the brain is influenced by a pulsed magnetic field. |
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