WFSBP 2011 PRAGA ANDREA MARQUEZ LOPEZ MATO

ANDREA MARQUEZ LOPEZ MATO Médica Psiquiatra. PNIE. Dolor Prof Psiconeuroinmunoendocrinología (UBA- Barcelo) Presidente electa CAPyN Miembro Honorífica FLAPNIE y AAPNIE Directora Instituto Psiquiatría Biológica Integral (ipbi) Presidente AAPB Presidente electa CANP Secretaria Científica FLAPB y AAPB Secretaria Científica FLAPB y AAPB Vicepresidente SAPNE Secretaria internacional AAP Secretaria adjunta FLAPB Secretaria GENBA LOPEZ MATO EX

Speaker Bureau and/or Consultant AstraZenecaBago Eli LillyBuxton Glaxo SmithKlineGador LundbeckRaffo PfizerRoemmers Roche Sanofi Aventis Servier

Terapéutica Quetiapina en depresión Azenapina en psicosis Agomelatina en depresión Zavesca (inhibidor de la glucosilceramida) para Niemman Pick C

Neurobiology of Depression Miller et al, 2009

Apoptotic and Necrotic Cells Release DAMPS INFLAMMATION

GR/Bcl-2 complex doesn’t translocate into the mitochondria -Reduction of mitochondrial function, Bcl-2 -Apoptosis Biphasic Effect of Glucocorticoid on Mitochondria GR complexes with Bcl-2 and translocates to mitochondria -Increases mitochondrial function -Neuroprotection -Adaptation to acute stressful events GCs acute treatment or low doses: GCs chronic treatment or high doses:

Neurotrophic factors inhibit apoptosis BDNF NGF NT-3 IGF GDNF VEGF... Cross Talk Between Extrinsic and Intrinsic Apoptotic Pathways

Biomarker Approach Metabolomics/ Proteomics Clinical Characterisation Genetics/Genomics Neuroimaging Bioinformatics

WFSBP Task Forces

Niveles de Evidencia

Especificadores Poblaciones especiales Diagnostic subtypes Sex differences Adolescents Elderly Pregnant and puerperium Cardiovascular disease Somatic comorbidity

Panic Disorder

GAD

Social Phobia Specific Phobia

OCD

PTSD

ATD Side Effects

Treatment of Personality Disorder

BDL Por rasgos: impulsividad, depresión, distorsión, cognitivos Nada para el vacio, el aburrimiento y la soledad Usar med de pocos efectos 2° por poca adherencia (LI, TPR) Avoidant Similar a TA Schizotypic Similar a Ez negativa y cognitiva

Acute Side Effects

Schizophrenia Long Term Treatment

Primer brote 1 o 2 años de tto para evitar recaída 6 meses con misma dosis Resto por lo menos 5 años con full dose o mayor Mejor SGA Técnicas para controlar side effects

Long Term Side Effects

Biological Markers

esquizofrenia Marcadores genéticos Neuroimagenes estáticas y funcionales Evaluación neurocognitiva Factores de crecimiento Inmunológicos NMEM?

La frutilla del postre… Articulo online de la semana pasada

In recent years, however, we have seen the emergence and refinement of a number of different technologies that I predict will, within our professional lifetimes and hopefully within the next 5 years, lead to the incorporation of laboratory-based tests for psychiatric diagnosis. When these will be proved to a satisfactory level of evidence and when they will be reimbursable by third- party payers, we can't know specifically, but I predict this will happen fairly soon. We are seeing the evidence of that even now.

What will these diagnostic tests be? The tests that appear to be emerging as the first to be marketed are ones that are based on the proteomic or metabolomic or biochemical analyses of plasma or cerebrospinal fluid. A series of different types of microarray panels have been developed that examine the profile of a series of analytes in plasma, serum, or cerebrospinal fluid. Using these, a certain profile, a biochemical signature if you will, has been found to correspond to specific psychiatric diagnoses. Several companies have developed data, applied for approval from the US Food and Drug Administration, and are beginning to market these tests. Some of these tests] are being used by a few psychiatrists, even though they still have not been accepted as a standard of care

A second modality that is likely to be implemented for psychiatric diagnosis is that of imaging techniques; here we're talking about both nuclear medicine imaging with PET and MR imaging with either structural, spectroscopic, or functional imaging applications. These have been used in a variety of disorders. They yield clear differences between diagnostic groups such as schizophrenia or depression and healthy controls or nonaffected individuals on the other. The problem is that the distributions of the values of the control vs patient groups still have too much overlap and are not sufficiently differentiated as to provide high enough positive predictive value at the individual patient or subject level. But I predict that it won't be too long before these are refined, the results will become more robust, and these will contribute to a profile or augment the information that clinicians have to establish their diagnosis..

Finally, genetic testing will also come into play. As you probably know, commercial companies already are marketing DNA testing. They provide a "readout" of your genotypes for all of the known coded human genes along with associations with specific diseases in the different organ systems that these correspond to, to the best level of evidence that currently exists. These are not accepted as medically validated and are not used routinely in clinical practice but there is no reason psychiatry cannot begin to use these as other fields of medicine have done. Because all mental disorders will almost certainly prove to be polygenic or multigenic, we will need a gene profile to utilize in term of diagnostic information

So, I encourage you to stay tuned, follow this literature, and be thinking about the fact that in the not-too-distant future, psychiatry will have laboratory-based methods to assist in our diagnoses. This should be an enormous benefit to our field in terms of enhancing the validity and precision of our diagnosis as well as elevating the scientific quality of clinical practice for the benefit of our patients. Dr. Jeffrey Lieberman for Medscape, september 2011

RESPUESTA ALM A MAIL DE AR Date: Sun, 9 Oct :41: Subject: Re: Y me preguntan porque trabajo tanto ??? From: To: estoy leyendo tu mail mientras preparo charla congreso aapb ayer prepare 2 charlas peru y esta tarde me espera terminar 3 caps para mi libro LA de PNIE todo trabajo con placer eso si, con juan que trabaja en otras cosas pero interrumpimos de tanto en tanto para besitos y algun drink te quiero Que genia ! Yo estoy en lo mismo preparando el de AAPB y otro más. Pero a mí me falta tener al lado "la compañía"... Don't worry...está cerca, lo se ( no alucino, eh ! es una sensación no más...) Un abrazo a los 2, yo también te quiero mucho, Adriana RESPUESTA AR MAIL DE ALM

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