gene polymorphism linked to PTSD

[PeeWee137]

http://www.time.com/time/health/article/0,8599,1723204,00.html

(i dont have access to the real paper in JAMA)

to summarize - in people with PTSD or a history of traumatic events, they found SNPs in the gene FKBP5, which is involved in the cortisol stress response system (HPA axis).
this gene has also been studied in the pathophys of depression and bipolar disorder.

do you think this will have an impact on PTSD treatment?

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[OldPsychDoc]

http://www.time.com/time/health/article/0,8599,1723204,00.html

(i dont have access to the real paper in JAMA)

to summarize - in people with PTSD or a history of traumatic events, they found SNPs in the gene FKBP5, which is involved in the cortisol stress response system (HPA axis).
this gene has also been studied in the pathophys of depression and bipolar disorder.

do you think this will have an impact on PTSD treatment?

Maybe the military could test everyone at enlistment and only send the "good " genes into combat?

 

[nancysinatra]

Maybe the military could test everyone at enlistment and only send the "good " genes into combat?

And Ob/Gyn clerkship directors could do the same thing! Those of us who don't make the cut could get diverted to a nice safe month of peds or something.

 

[whopper]

do you think this will have an impact on PTSD treatment?

Coming directly from the mouth of Charles Nemeroff (an expert on the subject & also the head of the psyche dept at Emory), at a lecture I attended, he said this possibly may affect how ERs handle patients who just experienced extreme psychological trauma that could cause PTSD. An example he gave was that such patients could have a lab test done testing for the specific genes prescence & that if positive, this would influence the clinician to be more sensitive to possible SSRI therapy & referral to mental health services. It could even possibly affect the way PTSD is diagnosed in the DSM.

However he stated that more research needed to be done. His proposals were conjecture.

 

[sunlioness]

That's just so silly. Why do you need an expensive lab test to tell you to do something you should be doing anyway?

 

[OldPsychDoc]

That's just so silly. Why do you need an expensive lab test to tell you to do something you should be doing anyway?

Because it justifies basic science research in the eyes of clinicians...

Seriously--every new finding in basic neurobiology MUST be followed by the obligatory "could lead to new treatments for ____" phrase, even if it has no current pragmatic value.

 

[Faebinder]

Gosh, you guys can be vicious.

I actually like seeing neuropsychiatry in action. We might in the future start using more bio indicators for depression or schizophrenia control. Sorta like Hemoglobin A1C tells you how well diabetes is under control.

 

[Anasazi23]

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[sunlioness]

Gosh, you guys can be vicious.

I actually like seeing neuropsychiatry in action. We might in the future start using more bio indicators for depression or schizophrenia control. Sorta like Hemoglobin A1C tells you how well diabetes is under control.

But can't we already tell how well these conditions are being controlled? If the space aliens are still coming around, the schizophrenia isn't under too great control. If my patient is talking about how the world is a deep dark place and she has no hope, then I wager that she's still depressed. And if patients are clinically doing well, why should I care if some bio marker says otherwise?

Diabetes is different. There really aren't day to day clinical indicators that tell you how well someone is controlling their sugars. They can feel totally fine and look totally fine to relatives until the complications set in years down the road. Thus you need something like glucometers and periodic A1Cs.

 

[OldPsychDoc]

Gosh, you guys can be vicious.

I actually like seeing neuropsychiatry in action. We might in the future start using more bio indicators for depression or schizophrenia control. Sorta like Hemoglobin A1C tells you how well diabetes is under control.

Look, I like it too. It's just that these reports are always SOOOO way overblown...then your patient comes in and says, "Well, aren't you going to TEST me for something????" And really--what do you do on the basis of an HgbA1C that you wouldn't have done anyway? Talk to them about compliance? When in your experience has an elevated GGT ever really helped you convince an alcoholic to get sober? I've got a patient now who uses her genetic diagnosis of being a "rapid metabolizer" as an excuse for needing humungous doses of oxycontin...

 

[Anasazi23]

I've got a patient now who uses her genetic diagnosis of being a "rapid metabolizer" as an excuse for needing humungous doses of oxycontin...

Hehe...I love that one.

I have a standard, canned response to that particular line.

Not safe for SDN, however.

 

[OldPsychDoc]

Hehe...I love that one.

I have a standard, canned response to that particular line.

Not safe for SDN, however.

OOOOoh. PM me, PLEASE!!!!

Of course, knowing that you're in NYC at the moment, I figure it's something like "Metabolize THIS!"

 

[Faebinder]

I imagine schizophrenia control to be a variable wave, not a straight line, similar to most forms of control systems in life. Influences include serum concentration and receptor sensitivity. I understand if the patient is not having bizare thoughts then they are controlled and if they are too sedated/slow then they are over controlled....but isnt that like saying "You are driving fast" or "You are driving slow" without giving the numbers. Do you think knowing someone is going 70 miles per hour vs 100 miles per hour is useful? They are both fast.

If practicality was always looked at when investigating basic science, we would never advance in science and never have what clinical abilities we have. Sometimes, a little of objectiveness to go with the subjectiveness is a good thing to clear things.

It's just my opinion.

 

[Anasazi23]

OOOOoh. PM me, PLEASE!!!!

Of course, knowing that you're in NYC at the moment, I figure it's something like "Metabolize THIS!"

It goes something like,

"If you're a drug addict and you have pain, life sucks. If you're a rapid metabolizer, it sucks that much harder."

Slightly edited...feel free to metabolize it in your own special way.