The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
Neuropsychiatric aspects of hiv infection and aidsRobin Victor
HIV & AIDS are closely related to psychiatry with the infection giving rise to many psychiatric problems and psychiatric illnesses leading to risk of acquiring HIV. Hence the approach to such a situation must be holistic with good coordination between medical specialists and psychiatrists, psychologists to bring maximum possible benefit to people with such a difficult illness
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
Neuropsychiatric aspects of hiv infection and aidsRobin Victor
HIV & AIDS are closely related to psychiatry with the infection giving rise to many psychiatric problems and psychiatric illnesses leading to risk of acquiring HIV. Hence the approach to such a situation must be holistic with good coordination between medical specialists and psychiatrists, psychologists to bring maximum possible benefit to people with such a difficult illness
Neuropsychiatric manifestations of other infectious and Prion diseasesSravanthi Penubarthi
Detailed neurological examination is necessary in all patients of psychiatric illnesses , especially with more of atypical presentation or poor response to treatment , to rule out any of the infectious causes.
In case of patients with psychiatric illnesses, with more of focal neurological deficits, one should consider the probability of any CNS infection.
Patients with atypical presentation of Psychiatric disorder with neurocognitive abnormalities, aggressiveness, late onset with acute behavioral symptoms, and lack of previous history of psychiatric illness , there is a need to consider syphilis.
A diagnosis of CJD should be considered when an adult patient develops dementia rapidly and myoclonus.
A journal club article review prepared for the Psychiatry Residency of Texas Tech El Paso - Paper title: 'Psilocybin Produces Substantial & Sustained Decreases in Depression & Anxiety in Patients With Life-threatening Cancer: A Randomized Double-Blind Trial'
Via Christi Women's Connection presentation on advance in depression treatment by Matthew Macaluso, DO, medical director of Via Christi Psychiatric Clinic.
Week 5 Focused SOAP Note and Patient Case Presentation Cosamirapdcosden
Week 5: Focused SOAP Note and Patient Case Presentation
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan 2 Practicum
Introduction
Psychosis is a mental condition in which a person's ideas and perceptions are disrupted,
and the individual may have difficulty distinguishing between what is real and what is not.
A health condition, medications, or drug usage can all contribute to psychosis. Delusions,
hallucinations, incomprehensible speech, and agitation are all possible signs; the patient has
incorrect beliefs and sees or hears things that others do not see or hear. The person suffering from
the disease is usually unaware of his or her actions. Medication, psychotherapy, peer support,
family support and education, and talk therapy are all options for treatment. More or less every
mental intervention is backed by evidence accumulated during the patient's initial interview; each
patient's therapy begins with a thorough medical and mental health evaluation, the incorporation
of trust, and a discussion of past mental health history, substance misuse history, family mental
health history, and so on. In this example, the patient's evaluation was documented, and a
diagnosis was made based on the information collected from the patient during the evaluation.
When the case was being developed, a therapeutic approach was designed. The patient is a 53-
year-old Caucasian male who was scheduled for an initial screening for a psychotic disorder after
his sister recommended a visit to the psychiatrist because patient's behavior changed since the
mother passed away.
Patient Initial: S.T Age: 53 Gender: Male
Subjective Data:
CC: "I was brought here by my sister because since my mother passed away, I was living on my
own and not bothering anyone. Those people outside my window they are after me. They just
want me dead".
HPI: When patient was asked " what people?". Patient said " the government sent them to get
me because my taxes are high". Suddenly patient asked the provider if she can see the birds or
hear any loud noise. The provider responded by redirecting the patient that she does not hear any
voice or see anything. When the provider how long he is been hearing the voices or seeing
things, patient said " for weeks, weeks and weeks". Patient also said the sister tapped her phone
with the government. When asked about sleep, patient said " I have not slept well because the
voices keep me up for days. I try to watch the TV, they poison my food on TV, I locked
everything down in the fridge". Suddenly patient asked " Can I smoke?". Provider said "no you
can't smoke here". Patient admit that he smokes all day about 3 packs a day. Drinks alcohol
which his sister purchased for him to last him for weeks. Patient denies use of drugs. Admit to
history of marijuana use 3 years ago before the m ...
Neuropsychiatric manifestations of other infectious and Prion diseasesSravanthi Penubarthi
Detailed neurological examination is necessary in all patients of psychiatric illnesses , especially with more of atypical presentation or poor response to treatment , to rule out any of the infectious causes.
In case of patients with psychiatric illnesses, with more of focal neurological deficits, one should consider the probability of any CNS infection.
Patients with atypical presentation of Psychiatric disorder with neurocognitive abnormalities, aggressiveness, late onset with acute behavioral symptoms, and lack of previous history of psychiatric illness , there is a need to consider syphilis.
A diagnosis of CJD should be considered when an adult patient develops dementia rapidly and myoclonus.
A journal club article review prepared for the Psychiatry Residency of Texas Tech El Paso - Paper title: 'Psilocybin Produces Substantial & Sustained Decreases in Depression & Anxiety in Patients With Life-threatening Cancer: A Randomized Double-Blind Trial'
Via Christi Women's Connection presentation on advance in depression treatment by Matthew Macaluso, DO, medical director of Via Christi Psychiatric Clinic.
Week 5 Focused SOAP Note and Patient Case Presentation Cosamirapdcosden
Week 5: Focused SOAP Note and Patient Case Presentation
College of Nursing-PMHNP, Walden University
NRNP 6675: PMHNP Care Across the Lifespan 2 Practicum
Introduction
Psychosis is a mental condition in which a person's ideas and perceptions are disrupted,
and the individual may have difficulty distinguishing between what is real and what is not.
A health condition, medications, or drug usage can all contribute to psychosis. Delusions,
hallucinations, incomprehensible speech, and agitation are all possible signs; the patient has
incorrect beliefs and sees or hears things that others do not see or hear. The person suffering from
the disease is usually unaware of his or her actions. Medication, psychotherapy, peer support,
family support and education, and talk therapy are all options for treatment. More or less every
mental intervention is backed by evidence accumulated during the patient's initial interview; each
patient's therapy begins with a thorough medical and mental health evaluation, the incorporation
of trust, and a discussion of past mental health history, substance misuse history, family mental
health history, and so on. In this example, the patient's evaluation was documented, and a
diagnosis was made based on the information collected from the patient during the evaluation.
When the case was being developed, a therapeutic approach was designed. The patient is a 53-
year-old Caucasian male who was scheduled for an initial screening for a psychotic disorder after
his sister recommended a visit to the psychiatrist because patient's behavior changed since the
mother passed away.
Patient Initial: S.T Age: 53 Gender: Male
Subjective Data:
CC: "I was brought here by my sister because since my mother passed away, I was living on my
own and not bothering anyone. Those people outside my window they are after me. They just
want me dead".
HPI: When patient was asked " what people?". Patient said " the government sent them to get
me because my taxes are high". Suddenly patient asked the provider if she can see the birds or
hear any loud noise. The provider responded by redirecting the patient that she does not hear any
voice or see anything. When the provider how long he is been hearing the voices or seeing
things, patient said " for weeks, weeks and weeks". Patient also said the sister tapped her phone
with the government. When asked about sleep, patient said " I have not slept well because the
voices keep me up for days. I try to watch the TV, they poison my food on TV, I locked
everything down in the fridge". Suddenly patient asked " Can I smoke?". Provider said "no you
can't smoke here". Patient admit that he smokes all day about 3 packs a day. Drinks alcohol
which his sister purchased for him to last him for weeks. Patient denies use of drugs. Admit to
history of marijuana use 3 years ago before the m ...
This ppt will provide you a brief yet effective information about major types of biomarkers, their definitions, their significance in disease dignosis & treatment, how they are being & are developed to be used as an effective dignostic tool for Cancer & their other future implications in other fields of medicine.
The basic aspects of drug discovery starts from target discovery and validation further going to lead identification and optimization. In this particular slide discussion is regarding the target discovery and the tools that have been utilized in this process.
Genetic and epigenetic biomarkers for therapeutic monitoring in neurological ...Pranav Sopory
Seminar held on Genetic and epigenetic biomarkers for therapeutic monitoring in neurological disorders.
Multiple Sclerosis, Alzheimer's Disease and Parkinson's Disease.
Biomarkers and epigenetic explained. New epigenetic drug targets.
Recent trends in genomic biomarkers pepgra healthcarePEPGRA Healthcare
Cardiovascular disease is a significant health concern worldwide despite having many genomics developments providing valuable new candidates for better biomarkers and novel therapeutic targets. The main integration of new technologies promises the discovery and validation of better biomarkers of the presence of cardio disease, its progression, and the response to treatment in this blog. Some of the features are:
1. Analyzing the Gene expression
2. Genome-wide association studies
3. Linkage analysis
4. Wrapping up...
Continue Reading: http://bit.ly/3bqq3Np
Contact us:
UK: +44-1143520021
US/Canada: +1-972-502-9262
India: +91-9884350006
Email id: sales.cro@pepgra.com
Website: www.pepgra.com
Recent Trends in Genomic Biomarkers - Pepgra HealthcarePEPGRA Healthcare
Cardiovascular disease is a significant health concern worldwide despite having many genomics developments providing valuable new candidates for better biomarkers and novel therapeutic targets. The main integration of new technologies promises the discovery and validation of better biomarkers of the presence of cardio disease, its progression, and the response to treatment in this blog. Some of the features are:
1. Analyzing the Gene expression
2. Genome-wide association studies
3. Linkage analysis
4. Wrapping up...
Continue Reading: http://bit.ly/3bqq3Np
Contact us:
UK: +44-1143520021
US/Canada: +1-972-502-9262
India: +91-9884350006
Email id: sales.cro@pepgra.com
Website: www.pepgra.com
iCAAD London 2019 - Antonio Metastasio - PERSONALISED MEDICINE IN THE TREATM...iCAADEvents
Personalised medicine is considered the next frontier of health care. The role of genetic testing in psychiatry and in addictions medicine, however, has been recently critically reviewed. Are genetic tests helpful in assessing and managing these conditions?
Biomarkers and their role in drug discovery and developmentDeepakPandey379
A brief introduction to biomarkers with ther history, types and an overview of the journey of biomarker from a hypothesis to a valid established diagnostic parameter.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. • A pinprick. A meter reading. Then an injection of a carefully calibrated
dose of a pharmacological compound that will restore the body’s
natural balance. For millions of people living with diabetes, this is
now part of their daily routine.
•For psychiatric disorders, such tests are just a
dream. What would it take to realize this dream?
3. “Psychiatry still relies on clinical
endpoints, which reflect how a
patient feels or functions, and some
might argue that this personal
experience can never be substituted
for by a surrogate marker.”
-The Lancet Editorial
4. During the last few years, an extraordinary effort has been made to identify
biomarkers as potential tools for improving prevention, diagnosis, drug response, and
drug development in psychiatric disorders.
Patients diagnosed with the same psychiatric illness present a great heterogeneity in
their clinical presentation.
This fact together with the incomplete knowledge of the neurochemical alterations
underlying mental disorders, contribute to the limited efficacy of current
pharmacological options.
In this respect, the identification of biomarkers in psychiatry is becoming essential to
facilitate diagnosis through the development of markers that allow stratifying groups
within the syndrome, which in turn may lead to more focused treatment options.
5. All types of mental illness, pharmacological treatment
options are scarce and present limited efficacy;
74% of patients suffering from chronic schizophrenia (SCZ) experienced
problems of treatment adherence within 18 months.
• CATIE study
Only 31% of patients with major depressive disorder (MDD) were in remission
after being treated with a selective serotonin reuptake inhibitor for a total of 14
weeks.
• STAR*D Trial
Only 24% of patients of Bipolar Disorder experienced a remission of
depression during 8 consecutive weeks.
• STEP-BD
7. Hope for Future??
Progress in human brain research and the
advent of new technologies, such as
‘omics’ technologies, offers the
opportunity for change mental health
treatment and outcomes in a near future.
The identification of biomarkers has
become a new promising tool for guiding
diagnosis, predicting clinical outcome and,
therefore, improving the understanding of
the pathophysiology of mental disorders.
8. Biomarker
“A characteristic that is objectively measured and
evaluated as an indication of normal biological
processes, pathogenic processes, or pharmacologic
responses to a therapeutic intervention”
Biomarker Definition Working Group, supported by the U.S. National Institute of Health (NIH), 2000
9. Biomarker
“A defined characteristic that is measured as an
indicator of normal biological processes,
pathogenic processes or responses to an exposure
or intervention”
FDA-NIH Biomarker working definition, 2016
10. Good biomarker
Measured with high reproducibility
Present a sizeable signal-to-noise ratio
Meet the condition of being modified in a dynamic and reliable way as the clinical
condition progress
Should be accessible for its detection and measurement
Being detected by histological or image/neuroimaging techniques
14. Samples And Techniques Used For The Searching Of Biomarkers
• Historically, plasma together with tissues
obtained from biopsies were one of the
most common samples.
• Additional body fluids readily available in
large amounts as urine, saliva, tear fluid,
sweat, amniotic, cerebrospinal and
pleural fluids, cervicovaginal secretion
and wound efflux.
• access to brain samples is of particular
interest (Brain banks)
15. Postmortem brain study limits so as to be unknown about course.
• The progress of functional neuroimaging has
allowed to study some neuronal functions
including alterations of local cerebral flow, energy
metabolism and neurotransmitter receptor density
and occupation over the course of disease.
• Nevertheless, functional neuroimaging fails to provide
information at cellular biochemistry level
• The access to this technique is limited due to its high
economic costs
16. Lymphocyte
• In this context, blood lymphocytes have gained special attention in the
searching of peripheral biomarkers.
• Lymphocytes can be isolated easily from blood samples and studied on
a daily basis allowing to monitor the course of the disease.
• Receptor properties and transduction processes of lymphocytes are
similar to those observed in the CNS.
• Close bidirectional interaction between the CNS and the immune
system, in particular with lymphocytes
17. To date, some genes such as c-fos, interleukins (IL-2, IL-4, IL-6, IL-
10), nerve growth factor (NGF), brain-derived neurotrophic factor
(BDNF), cannabinoid receptors, acetylcholine, GABAA receptors,
B2-adrenergic receptors, glucocorticoid receptors, mineralocorticoid
receptors, D3 dopaminergic receptor, and serotonin receptors have
been analyzed in lymphocytes from psychiatric patients, with promising
results as peripheral biomarkers.
Thus, gene expression studies in lymphocytes of psychiatric patients at
different stages of the disease, that may reflect alterations in the CNS,
would allow to further characterize the mechanisms underlying the
pathogenesis of the disease and may contribute to predict the
pharmacological treatment response (biomarkers of treatment outcome)
20. Genomic Biomarkers
“a measurable DNA and/or RNA characteristic that is an indicator of normal biologic
processes, pathogenic processes, and/or response to therapeutic or other interventions”.
These measurable features include the expression, function and regulation of a
particular gene.
In the DNA, these features can be characterized by single nucleotide polymorphisms
(SNPs), variability of short sequence repeats, haplotypes, deletions or insertions of (a)
single nucleotide (s), copy number variations and cytogenetic rearrangements
(translocations, duplications, deletions or inversions).
21. Genomic Biomarkers
The use of genetic techniques allowed the analysis of candidate genes,
genome-wide studies, and polygenetic risk score analysis to understand
multiple psychiatric disorders such as SCZ.
These techniques include Comparative Genomic Hybridization (CGH),
microarray, exome sequencing, and whole genome sequence.
Specifically, pharmacogenomics is crucial to identifying genetic
polymorphisms in drug-metabolizing enzymes, transporters, receptors, and
other drug targets, essential to drug discovery and drug therapy optimization.
22. Genomic Biomarkers
Genome-wide association studies have allowed the identification of potential genomic biomarkers in
different neuropsychiatric and drug-use disorders.
For example, the Collaborative Study of the Genetics of Alcoholism (COGA) have correlated the
• SNPs rs4780836 [A > C; chromosome 16:19974071 (GRCh38.p12)], rs2605140 [A > G; chromosome 17: 18253061
(GRCh38.p12)], rs11690265 [chromosome 2: C > T; chr2:27418655 (GRCh38.p12)], rs692854 [non-functional Se (FUT2)
gene; alleles C > A; chromosome 19: 48706207 (GRCh38.p12)], and rs13380649 (alleles A > G; chromosome 16:
19999778 (GRCh38.p12)]
with greater vulnerability and predisposition to develop alcohol use disorders (AUD) in European
American and African American.
Besides, the study has demonstrated that there is a correlation between these SNPs and alterations in
electroencephalograms, such as lower posterior gamma, higher slow wave connectivity (delta, theta,
alpha), higher frontal gamma ratio, and higher beta correlation in the parietal area of patients with AUD.
23. Genomic Biomarkers
In bipolar disorder (BD), the SNP rs17026688 in the gene encoding glutamate
decarboxylase-like protein 1 (GADL1) has been associated with the response to lithium
in Chinese patients.
This SNP has been related to immune dysfunctions in BD patients, such as higher
percentages of total T cells, CD4+ T cells, activated B cells and monocytes.
Besides, treatment of BD patients-derived peripheral blood mononuclear cells (PBMCs)
with lithium in vitro increases the immune response (CD4+ cells).
These findings suggest that the immune imbalance might not only be a biomarker for
diagnosis but also a biomarker of the disease progression and therapeutic response in
BD.
24. Genomic Biomarkers
DNA genomic biomarkers as a useful indicator of the state of the disease
(severity) also presented relevant consequences for the clinical management of
neuropsychiatric diseases.
In this respect, a recent study revealed a close relationship between the SNPs
rs1360780 in the FK506- binding protein 5 (FKBP5) gene and rs17689918 in
the corticotrophin-releasing hormone receptor 1 (CRHR1) gene and greater
severity of the disease in posttraumatic stress disorder (PTSD) patients
25.
26. Transcriptomic Biomarkers
The transcriptome is defined as the complete set of all RNA molecules in one
cell or a population of cells at a specific developmental stage or physiological
condition.
Measuring the expression of an organism’s genes as a snapshot in different
tissues, conditions, or time points provides information on how genes are
regulated and would contribute to a better understanding of human diseases
and their pharmacological treatment, allowing to identify potential therapeutic
biomarkers when variations in treatment outcomes occur.
27. Transcriptomic Biomarkers
Transcriptomics studies identified that the efficacy of antidepressants is related
to gene expression changes at a transcriptome-wide scale.
In a microarray study, alterations of MMO28 and KXD1 genes encoding for
matrix metallopeptidase 28 and KxDL motif-containing protein 1, respectively,
were associated with better response to nortriptyline in depressive patients.
This data could contribute to improve the characterization of the molecular
pathways underlying the efficacy of antidepressants.
28. Transcriptomic Biomarkers
A clinical study associated new miRNAs (miR146a-5p, miR-146b-5p, miR-24-3p,
and miR-425-3p) with the effectiveness of antidepressant drugs such as duloxetine,
escitalopram, and nortriptyline, in patients with MDD.
These miRNAs are ubiquitously expressed and highly correlated in blood and in
brain tissue, playing an important role in the regulation of the mitogen-activated
protein kinase (MAPK) and Wnt signaling pathways, closely related with stress
response and MDD
29. Transcriptomic Biomarkers
Treatment with topiramate significantly modified the gene expression of specified
genes GRINA, PRKACA, PRKCI, SNAP23, and TRAK2 involved in severe
pathways underlying drug addiction and other relevant physiological functions,
including neuronal function/synaptic plasticity, signal transduction, cardiovascular
function, and inflammation/immune response
30. Proteomic Biomarkers
Proteomics approaches using blood, plasma or serum constitute a highly desired method for
biomarker profiling of psychiatric disorders, due to the fact that these biological samples are
used for routine diagnostic analyses in clinical practice, making it easier to obtain samples.
The cerebrospinal fluid (CSF) is a sample of particular interest for the identification of potential
proteomic biomarkers due to its proximity to the brain.
Although its collecting is very complex, due to the invasive procedure involved, it contains
much less proteins than plasma.
• The “buffering” of protein composition is much weaker and tend to lead in a reduction of chances to identify potential
proteomic biomarkers.
31. Proteomic Biomarkers
To consider a potential proteomic biomarker, it is necessary to evaluate
its sensitivity, specificity, and positive or negative predictive values
upon the disease of interest.
32. Proteomic Biomarkers
Proteome studies carried out in blood plasma, serum, and postmortem brain tissue from SCZ patients
identified alterations in proteins that play a significant role in neuronal transmission and synaptic
function, calcium homeostasis, and signaling, energy metabolism, oxidative stress, cytoskeleton and in
the immune system and inflammation.
These proteins have been proposed as biomarker candidates for prognosis, diagnosis, and medication
monitoring in SCZ.
Zinc finger protein 729 that was found significantly downregulated in patients with SCZ compared to
healthy individuals and patients diagnosed with depression or BD
reduced plasma levels of glia maturation factor beta (GMF-b), the brain-derived neurotrophic factor
(BDNF), and the 115-kDa isoform of the Rab3 GTPase activating protein catalytic subunit
(RAB3GAP1) in SCZ patients.
33. Proteomic Biomarkers
Acetyl-l-carnitine (LAC) has been proposed as a proteomic biomarker in MDD.
LAC plays an important role in several behavioral features.
The reduction of LAC concentrations was associated with abnormal hippocampal glutamatergic
function and plasticity.
Such alterations suggested that the degree of LAC deficiency was directly proportional with the
severity, the age of MDD onset, and the clinical history of treatment-resistant depression (TRD).
These findings suggest that LAC may be useful as a diagnostic and prognosis biomarker for
MDD.
34. Proteomic Biomarkers
Neurofilaments light chains (NF-L) have been proposed as potential biomarkers
for neuronal damage in certain psychiatric diseases.
In the plasma of female patients affected by anorexia nervosa, levels of NF-L were
significantly elevated, being associated with the neuronal damage observed in AN
patients, which partially normalizes with weight recovery
35. Proteomic Biomarkers
An additional study pointed out the potential role of NF-L as a discriminative
biomarker between primary psychiatric disorders and neurodegenerative clinical
conditions with wide-ranging of behavioral, psychiatric, and cognitive symptoms.
elevated concentrations of NF-L have been observed in the CSF of BD patients.
Studies demonstrated that there is a positive correlation between CSF NF-L levels
and the response to antipsychotics and lithium
36. Metabolomics Biomarkers
This technology focuses on the presence of small molecules metabolites in various
complex matrices like CSF, blood, urine, saliva, and other human fluids.
The metabolome is inherently more dynamic and time sensitive than proteome and
genome, providing a direct functional measure of cellular activity and physiological
status.
Changes in metabolome are the consequence of the interaction between lifestyle,
environmental, genetic, developmental, and pathological factors.
Consequently, metabolomics are of particular interest because, in contrast to
genomics, captures the dynamic nature of the disease, and in contrast to proteomics,
metabolomics measure the final products produced by complex interactions between
proteins, signalling cascades and cellular environments.
37. Metabolomics Biomarkers
Metabolomics biomarkers are not characterized by one single metabolite.
Rather, they are a set of correlated metabolites defining a specific state of disease
or the response to a clinical or pharmacological intervention.
Currently, gas chromatography-mass spectrometry (GC-MS), liquid
chromatography-mass spectrometry (LC-MS), and nuclear magnetic
resonance (NMR) are the main types of analytical platforms used in the searching
for metabolomics biomarkers.
38. Metabolomics Biomarkers
77 urinary metabolites were identified in children with autism spectrum disorder treated
with sulforaphane, a supplement that significantly improved social responsiveness.
Some of these metabolites play a role in the regulation of neurotransmitters, hormones,
oxidative stress, amino acid/gut microbiome, and sphingomyelin metabolism.
A study conducted in patients with symptoms of depression, tried to found a predictor or a
biological correlation of depression recovery after the administration of certain
antidepressants including escitalopram, bupropionescitalopram, or venlafaxine-mirtazapine
combinations.
• An increase of phosphatidylcholine C38:1 baseline plasma concentrations was associated with poorer
outcome in patients.
• In contrast, an increased ratio in hydroxylated sphingomyelins after 8 weeks of treatment was linked to
symptoms recovery
39. Epigenetic Biomarkers
An epigenetic biomarker is defined as “any epigenetic mark or altered epigenetic
mechanism that can be measured in the body fluids or tissues defining a disease
(detection); predicts the outcome of disease (prognostic), responds to therapy
(predictive); monitors responses to therapy or medication (therapy monitoring) and
predicts risk of future disease development (risk)”
40. Take Home Message
• There are several proteins, metabolites, and genes that have been
linked with certain neuropsychiatric diseases mainly due to the
advance in ‘omics' technologies.
• However, none of them have been demonstrated to be a real and useful
biomarker in clinical practice.
• Three essential key targets are in common to advance in the search of
biomarkers in neuropsychiatry:
• 1) accurate selection of the clinical population
• 2) shortened sampling time and
• 3) standardization of procedures for sample processing.
The simultaneous presence of two or more psychiatric diseases are associated with greater severity, worse response to the pharmacological treatment and have a greater risk of suicide than either condition alone.
genomics, transcriptomics, proteomics, or metabolomics.
However, systematic biochemical investigations using these samples are scarce, limited and unrealistic mainly to the fact that the course of the disease cannot be monitored
For instance, peripheral cytokines released by lymphocytes modify CNS functions including its autonomic control as well as neuroendocrine and behavioral responses. Besides, several evidences suggested that alterations in neurotransmitters and hypothalamic-pituitary-adrenal (HPA) axis in the CNS are concomitant with alterations in the function and metabolism of lymphocytes
Thus, transcriptome is dynamic and reflects the cellular state.