Application of a Pharmacogenetics-Based Precision Medicine Model (5SPM) to Psychotic Patients That Presented Poor Response to Neuroleptic Therapy

Antipsychotics are the keystone of the treatment of severe and prolonged mental disorders. However, there are many risks associated with these drugs and not all patients undergo full therapeutic profit from them. The application of the 5 Step Precision Medicine model(5SPM), based on the analysis of the pharmacogenetic profile of each patient, could be a helpful tool to solve many of the problematics traditionally associated with the neuroleptic treatment. In order to solve this question, a cohort of psychotic patients that showed poor clinical evolution was analyzed. After evaluating the relationship between the prescribed treatment and pharmacogenetic profile of each patient, a great number of pharmacological interactions and pharmacogenetical conflicts were found. After reconsidering the treatment of the conflictive cases, patients showed a substantial reduction on mean daily doses and polytherapy cases, which may cause less risk of adverse effects, greater adherence, and a reduction on economic costs.

Painless Legs and Moving Toes Presenting as a Tardive Phenomenon: Case Report and Review of the Literature

Painless legs and moving toes syndrome is a rare movement disorder. Various conditions like spinal cord trauma, lumbar radiculopathy, peripheral neuropathy, neuroleptic treatment, or traumatic lesions of the soft tissues of the foot can present with this disorder. In our case report, we aim to report a case of a young woman who developed painless legs and moving toes in the setting of chronic neuroleptic usage, which improved after the discontinuation of antipsychotics and treatment with clonazepam. We describe in detail her presentation and clinical examination, along with the review of the literature.

M17. PREDICTION OF NEUROLEPTIC AND ANTIDEPRESSANT TREATMENT RESPONSES VIA FMRI OF THE EXTENDED REWARD SYSTEM

Background Neuroimaging techniques have been developed as important tools to assess brain dysfunctions that underlie mental disorders. In particular, modern functional magnetic resonance imaging (fMRI) holds the promise to provide neurofunctional biomarkers for improved differential diagnosis and optimized treatment of schizophrenic and affective disorders. Methods Neurofunctional connectivity MRI of the extended human reward system (Makris et al., 2008) was conducted in a large transnosological cohort of patients suffering from schizophrenia, bipolar disorder or major depressive disorder. Responses to neuroleptic treatments in patients with schizophrenic or bipolar disorder were determined retrospectively, while treatment responses to different antidepressants were directly assessed in a prospective naturalistic clinical study. Results Responders to neuroleptic treatment with aripiprazole showed significantly higher reward-related activation in a larger set of brain regions (including ventral striatum, hippocampus, amygdala, pregenual ACC and anteroventral PFC) in comparison to non-responders to aripiprazole. This finding proved to be specific for this neuroleptic treatment when compared to treatments with other atypical or typical neuroleptics. Pre-treatment reward-related activation of the nucleus accumbens, the ventral tegmental area and the amygdala showed a substance-class specific correlation with subsequent antidepressant treatment responses to SSRIs and/or agomelatine. Discussion These findings of ongoing studies exemplify the high potential of neuroimaging techniques to foster the development of precision medicine in psychiatry. The identification of neuroimaging markers associated with specific treatment responses may allow the development of “tailored”, i.e. stratified treatment approaches.

Neuroleptic malignant syndrome: Case report and literature review

IntroductionNeuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal adverse effect of neuroleptic, both classic and atypical drugs.ObjectiveTo review the incidence, clinical characteristics, diagnosis and treatment of NMS.AimWe have described the case of a man of 32 years of age diagnosed with bipolar disorder treated with lithium. He precised high-dose corticosteroids after having tonsillitis. Then, he presented manic decompensation requiring neuroleptic treatment (oral risperidone). After 72 hours, he presented an episode characterized by muscular rigidity, fever, altered mental status and autonomic dysfunction. Life support measures and suspension of neuroleptic treatment were required.MethodsA literature review of the NMS was performed using the PubMed database.ResultsThe frequency of NMS ranges from 0.02 to 2.4%. The pathophysiology is not clearly understood but the blockade of dopamine receptors seems to be the central mechanism. Some of the main risk factors described are: being a young adult, the concomitant use of lithium and metabolic causes, among others. NMS occurs most often during the first week of treatment or after increasing the dosage of the neuroleptic medication. Some issues of NMS are those related with diagnosis, treatment and reintroduction of antipsychotic treatment or not.ConclusionsNMS can be difficult to diagnose due to the variability in the clinical symptoms and presentation. Because of it diagnosis is of exclusion, clinicians should always take it into consideration when a patient is treating with neuroleptic, especially when the dosage has been recently increased. NMS is a clinical emergency.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychotic and obsessive symptoms: A case report

A 28-year-old patient who began three months of symptoms of low mood, apathy and anhedonia. The patient in this last month had accepted a job but the first day had left by “feeling incapable”. He asked for specialized help. He was diagnosed with severe depressive episode and antidepressant treatment. Some weeks of patient treatment did not improve. He began to voice greater feelings of hopelessness and ideas of active death secondary to his process. He was admitted a partial hospitalization for further control and evaluation. In his evolution, visual hallucinations and a mild delusional ideation of unstructured surveillance and injury were observed. The patient verbalized with little repercussion these sensoperceptive alterations. Neuroleptic treatment was given but we could not manage high doses because of poor tolerance and side effects of treatment. The symptomatology did not improve and the patient's anguish increased. In the moments of greater distress, the patient performed superficial cuts on his forearms that he criticized. During the following months, symptoms of an obsessive type were observed, which had already pre-entered but had been reactivated. He began to perform rituals of verification with important repercussion.DiscussionIn the scientific literature the relationship between psychosis and obsession has been studied on many occasions, without reaching firm conclusions. In 2004, Poyurosvsky postulated the possible diagnosis of a subgroup called “schizo-obsessive” that included both disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.