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Panic Disorder01:27

Panic Disorder

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Panic disorder is an anxiety disorder characterized by recurrent and sudden minutes-long episodes of intense fear, known as panic attacks. These attacks may feel like heart attacks and often happen without warning or a specific cause. They can include symptoms such as rapid heart rate, shortness of breath, chest pain, trembling, sweating, dizziness, and a sense of helplessness. During a panic attack, individuals may feel as though they are experiencing a heart attack or are in a...
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Antipsychotic drugs are a crucial treatment method for acute and chronic psychoses, bipolar illness, and behavioral disorders. The selection of these drugs depends on several factors, including the state of the disease, clinical judgment, possible drug interactions, and the patient's sensitivity to adverse effects. In immediate scenarios, such as delirium and dementia, short-term treatment with low doses of high-potency typical or atypical agents can effectively manage symptom exacerbation.
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The elimination half-life and drug clearance of drugs following nonlinear kinetics can vary with dosage. The Michaelis-Menten parameters and drug concentration influence these factors. As the dose increases, the elimination half-life tends to lengthen, resulting in a reduction in clearance and a disproportionately larger area under the curve. The total clearance can be derived from the Michaelis-Menten equation for drugs following a one-compartment model.
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Human Genetics01:28

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Human genetics provides a profound framework for understanding the interplay between genetic predispositions and human psychology. At the heart of this discipline lies the study of how genes influence physical traits, behaviors, and susceptibility to diseases. Each person carries a unique genetic code that subtly or significantly shapes their psychological and behavioral landscape.
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Pharmacogenetic Testing in Treatment-resistant Panic Disorder: a Preliminary Analysis.

Marcos Fidry1, Morena Mourao Zugliani1, Mariana Costa do Cabo1

  • 1Laboratory of Panic and Respiration, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ). Rio de Janeiro, RJ, Brazil.

Clinical Practice and Epidemiology in Mental Health : CP & EMH
|January 22, 2025
PubMed
Summary

Pharmacogenetic testing showed limited ability to predict treatment outcomes in patients with treatment-resistant panic disorder (PD). Further research is needed to explore the links between PD treatment resistance and specific genes like MTHFR and ABCB1.

Keywords:
ABCB1 proteinCytochrome P450Folic acidMethylenetetrahydrofolate reductaseNeuropharmacologyPharmacokineticsTreatment-resistant anxiety disorder

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Area of Science:

  • Pharmacology
  • Genetics
  • Psychiatry

Background:

  • Panic disorder (PD) affects 20-40% of patients who are resistant to pharmacological treatments.
  • Pharmacogenetics may offer insights into treatment resistance in PD.
  • Current treatments for PD do not work for all patients.

Purpose of the Study:

  • To assess the clinical utility of pharmacogenetic testing in patients with treatment-resistant PD.
  • To gather preliminary data on the effectiveness of pharmacogenetic testing for PD.
  • To explore genetic markers associated with PD treatment outcomes.

Main Methods:

  • An observational study included twenty patients with treatment-resistant PD.
  • Commercial pharmacogenetic testing was performed on all participants.
  • The testing panel analyzed gene polymorphisms including CYP, EPHX1, UGT1A4, UGT2B15, ABCB1, ADRA2A, ANKK1, COMT, DRD2, FKBP5, GRIK4, GSK3B, HTR1A, HTR2A, HTR2C, MC4R, OPRM1, SCN1A, SLC6A4, and MTHFR.

Main Results:

  • Pharmacogenetic tests indicated a reduced chance of response in 30% of patients.
  • Tests suggested very low serum drug levels in 20% of patients.
  • Reduced MTHFR enzyme activity was predicted in 74% of patients, and ABCB1 gene alleles linked to drug resistance were found in 90%.

Conclusions:

  • Commercial pharmacogenetic testing did not reliably predict negative treatment outcomes in most PD patients.
  • The association between PD treatment resistance and CYP2C19, MTHFR, and ABCB1 genes warrants further investigation.
  • Pharmacogenetics may play a role in understanding and treating PD, but more research is needed.