Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Sz and experimental medicine


Published on

  • Be the first to comment

Sz and experimental medicine

  1. 1. Experimental medicine: Schizophrenia Update Richard Drake Institute of Brain, Behaviour & Mental Health
  2. 2. Understanding processes• Pharmacogenomics – Predictors of prognosis – Predictors of response• Proteomics, PET – Markers of relapse or response – Identify key processes – Predict outcomes Martins-de-Souza D., et al. Expert Rev Proteomics. 2012;9(1):97-108
  3. 3. Novick D et al (2009)Eur Neuropsychopharmacol 19 (8);542-50
  4. 4. APS Weight gain• h2 40-70%• Worse if 5HT2c wild-type (cf MC4R) – Han Chinese & Spanish (also UK haplotype) – CPZ, RSP; OLZ, misc. APS Foley DL & Morely KI (2011) Arch Gen Psych epub 7.2.11• Metformin RCTs have mixed results• 750-1000mg/d efficacious in earlier illness, weight gain group, Chinese• May normalise menstruation Wu RR et al. Am J Psychiatry 2012;169:813-821
  5. 5. Other Biomarkers• sMRI• fMRI• Cognition – E.g. cognitive impairment always predictive of poor prognosis – Improvement in cognition predicts improvement in social function
  6. 6. Sz trials• NEWMEDS – Trial design (CT + CE) – New Tools• OPTIMISE – Novel agents – Novel biomarkers (proteomics, sMRI)• IMPACT (CR + CBTp)• BeneMin
  7. 7. NEWMEDS PoC design n=40 modafinil placebo CTMCCB MCCB MCCB MCCB MCCBSB SB SB SB SB
  8. 8. mHealth• Experience Sampling Methodology• ClinTouch• World of Apps
  9. 9. Cannabidiol v AMS Leweke FM et al., Transl Psychiatry 2012:2;e94. doi:10.1038/tp.2012.15
  10. 10. FIGURE 1Eicosapentaenoic Acid Interventions in Schizophrenia: FIGURE 1 . Meta-analysis of double-blind placebo-Meta-Analysis of Randomized, Placebo-Controlled controlled EPA studies in DSM-IV schizophrenia.Studies. Random-effects model of individual and overall (last lineFusar-Poli, Paolo; Berger, Gregor of the plot) Hedges g estimate (95% confidence interval) of the effect of EPA augmentations strategies asJournal of Clinical Psychopharmacology. 32(2):179-185, compared with placebo (standard antipsychoticApril 2012. treatment) on psychotic symptoms.20,34-38DOI: 10.1097/JCP.0b013e318248b7bb © 2012 Lippincott Williams & Wilkins, Inc. Published by Lippincott Williams & Wilkins, Inc. 2
  11. 11. Oxytocin90807060 PLC OTC504030 BL 1 2 3 Feifel D et al., Biol Psych 2010 68(7) 678-80
  12. 12. Other adjunctives• Glutamatergic – [LY2140023, memantine]• Serotonergic – [MTZ, CTL, ondansetron]• Anti-inflammatory – [simvastatin, aspirin, cloecoxib]• HPA axis – [pregnenolone]• B12, folate
  13. 13. Novel psychological interventions• CR – CR + CE – CR + CBTp• Novel therapies – New applications of CBT – Adaptations of FI
  14. 14. CR + CT
  15. 15. Mean PSYRATS scores
  16. 16. RABIES
  17. 17. The MHRN environment• Hubs• CSOs’ role
  18. 18. Summary• Personalised medicine is still coming• Proteomics & Genomics: – interesting findings but methodological difficulties• Trial methodology continues to progress• Novel agents: – side effects and cognition are the current foci; – but novel APS mechanisms are an old favourite