SYMPOSIA

Abstracts of the Invited Speakers
or lamotrigine are listed as recommended medications to prevent recurrent episodes.
NICE Treatment Guidelines: They recommend at least 2 year of maintenance treatment after 1 episode. Long term preventive treatment
should be considered in the following cases: One manic episode with prominent risk factors and negative results and bipolar II cases
with significant functional loss, suicide risk, and frequent recurrent episodes. Lithium, olanzapine, or valproate can be used in long term
maintenance treatment, but valproate should not be used in women with pregnancy potential.
When monotherapy with one of those is not adequate, one of three can be added as a second agent or monotherapy can be tried with a
different agent. Possible combinations are lithium-valproate, lithium-olanzapine, or valproate-olanzapine.
Turkish Psychiatry Association Guidelines: Maintenance treatment is suggested in general after second episode, but it can be started in cases
with risk factors. If a mood stabilizer was initiated during acute phase, it should be continued in maintenance phase, if not, then one should be
started. When a mood stabilizer will be chosen for maintenance phase, it should be lithium. After second episode, whatever the type of episode
was, the same mood stabilizer should be continued if there was one. When there is not adequate response and recurrence occurs a second
mood stabilizer should be added. In cases using lithium as first mood stabilizer, valproate should be given priority as the second mood stabilizer.
In conclusion, even there are similarities in many areas among guidelines, there are also different recommendations regarding treatment options.
Those differences stem from complex clinical presentations of bipolar disorder and different cultural and traditional treatment approaches.
Key words: Bipolar disorder, maintenance phase, guidelines
References:
1. Fountoulakis KN, Vieta E, Sanchez-Moreno J, Kaprinis SG, Goikolea JM, Kaprinis GS. Tretament guidelines for bipolar disorder: A critical review. J Affective Dis 2005;
86: 1-10.
2. Perlis RH. Use of treatment guidelines in clinical decision making in bipolar diorder: a pilot survey of clinicians. Curr Med Res Opin 2007; 23; 467-475.
3. Samalin L, Guillaume S, Auclair C, Llorca PM. J Nerv Ment Dis 2011; 199: 239-243.
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S99-100
[PS-23]
Symposium Title: Individualized medicine: Focus on pharmacogenetics
Genetics and drugs: From research to clinical studies Turkish perspective
Cem Şengül
Pamukkale University, School of Medicine, Department of Psychiatry, Denizli, Turkey
E-mail: acemsen@gmail.com
Genetic studies in psychiatry are on the rise and they form an important portion of all psychiatric research in last years. The genetic studies
in psychiatry vary from classical association and linkage studies to genome wide association, and copy number variant studies. Genetic
studies were focusing on different dimensions of psychiatric conditions. First of all, associations of target genes with psychiatric disorders
were investigated in majority of studies. Association of drugs and genetics were also studied in many research projects. Genetic drug
association studies consist of studies with efficacy and frequency of side effects of drug on different genetic polymorphisms. Recently,
μ-opiate receptor gene (OPRM1) Asn40Asp single-nucleotide polymorphism was found to be associated with naltrexone drug response in
alcoholic patients. This finding was very important for revealing effect of genetics on drug response. Naltrexone was effective in aspartate
(Asp) 40 allele carriers but drug was ineffective in homozygote asparagine (Asn) carriers. Different genetic polymorphisms of genes
encoding enzymes and receptors that were related to dopaminergic, serotonergic and glutamatergic systems were also associated with
antipsychotic and antidepressant drug response and side effects. For example 5-HT2C receptor 759C/T gene polymorphism was associated
with antipsychotic induced weight gain and T102C polymorphism of 5HT2A receptor gene was associated with response to risperidone.
Genome wide association and copy number variations are new genetic techniques revealing more detailed and reliable results. Studies
using these techniques might be more useful for exploring interactions between drugs and genetics. Studies on association of genetics
with psychiatric disorders were limited and there were only a few studies available on association of genetics with psychiatric drugs in
Turkey. Financial problems and approval speed and requirements of ethics committees are important barriers for conducting studies on
genetic drug interaction. Resolving these issues might increase interest of psychiatrists on this topic.
Key words: Genetics, polymorphism, drug
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S100
S100 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org