Pharmacological management of neuropsychiatric symptoms in patients with major neurocognitive disorders

Elie, Dominique; Rej, Soham

doi:10.1503/jpn.170117

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…Antipsychotics represent the mainstay in the treatment of schizophrenia and schizophrenia spectrum disorders and are among the principal therapeutic options for bipolar disorder (National institute for Heath and Care excellence NICE, 2014; Taylor et al, 2018;Yatham et al, 2018). Some antipsychotics can also be used as add-ons for treatment resistant unipolar major depression (Cantù et al, 2021) and many are extensively prescribed off-label for anxiety disorders (Pies, 2009;Hershenberg et al, 2014;Pignon et al, 2017), personality disorders (Rosenbluth and Sinyor, 2012;Wasylyshen and Williams, 2016;Yadav, 2020) and organic mental disorders (Elie and Rej, 2018). In the treatment of psychosis, response rates range from 47% for individuals who have received prior treatment to 66% for antipsychotic-naive individuals (Haddad and Correll, 2018), while 1-year discontinuation rates may be as high as 74% due to poor tolerability and/or lack of efficacy (Lieberman et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Prediction of antipsychotics efficacy based on a polygenic risk score: a real-world cohort study

De Pieri,

Ferrari,

Pistis

et al. 2024

Front. Pharmacol.

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Background: Response to antipsychotics is subject to a wide interindividual variability, due to genetic and non-genetic factors. Several single nucleotide polymorphisms (SNPs) have been associated with response to antipsychotics in genome-wide association studies (GWAS). Polygenic risk scores (PRS) are a powerful tool to aggregate into a single measure the small effects of multiple risk alleles.Materials and methods: We studied the association between a PRS composed of SNPs associated with response to antipsychotics in GWAS studies (PRSresponse) in a real-world sample of patients (N = 460) with different diagnoses (schizophrenia spectrum, bipolar, depressive, neurocognitive, substance use disorders and miscellaneous). Two other PRSs composed of SNPs previously associated with risk of schizophrenia (PRSschizophrenia1 and PRSschizophrenia2) were also tested for their association with response to treatment.Results: PRSresponse was significantly associated with response to antipsychotics considering the whole cohort (OR = 1.14, CI = 1.03–1.26, p = 0.010), the subgroup of patients with schizophrenia, schizoaffective disorder or bipolar disorder (OR = 1.18, CI = 1.02–1.37, p = 0.022, N = 235), with schizophrenia or schizoaffective disorder (OR = 1.24, CI = 1.04–1.47, p = 0.01, N = 176) and with schizophrenia (OR = 1.27, CI = 1.04–1.55, p = 0.01, N = 149). Sensitivity and specificity were sub-optimal (schizophrenia 62%, 61%; schizophrenia spectrum 56%, 55%; schizophrenia spectrum plus bipolar disorder 60%, 56%; all patients 63%, 58%, respectively). PRSschizophrenia1 and PRSschizophrenia2 were not significantly associated with response to treatment.Conclusion: PRSresponse defined from GWAS studies is significantly associated with response to antipsychotics in a real-world cohort; however, the results of the sensitivity-specificity analysis preclude its use as a predictive tool in clinical practice.

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