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November 10, 2019

The 2019 NEI Congress Scientific Poster Session and Reception was held on Friday, November 9 and featured nearly 100 posters covering the full spectrum of mental health research and clinical data. Among them, three particularly stood out for the quality of their data and contributions to the field. Presented below are the winners of the 2019 NEI Congress Young Investigator Poster Competition.

FIRST PLACE

Implementation of Personalized Medicine in a Community Psychiatry Practice

Audrey Umbreit, PharmD¹; Shirshendu Sinha, MBBS²; Emily Holm, PharmD¹

¹Department of Pharmacy, Mayo Clinic Health System and Mayo Clinic College of Medicine and Science, Mankato, MN, USA; ²Department of Psychiatry and Psychology, Mayo Clinic Health System and Mayo Clinic College of Medicine and Science, Mankato, MN, USA

Objective: To describe the initial results of implementing pharmacogenomics (PGx) testing in a community-based psychiatry practice and potential impacts on medication management.

Methods: Retrospective chart review of prospectively maintained medical records of all adult patients with pharmacogenomics results from 9/01/2017 to 6/30/2019 under the care of psychiatrist and clinical pharmacist.

Results: A total of 51 patients met inclusion criteria. A total of 7 pharmacokinetic genes and, due to changes in the test report over time, a range of 6-10 pharmacodynamic genes relevant to psychotropic medications were evaluated per patient. Every patient had genetic variations, with an average of 6.1 per patient (range 3-9; SD= 1.5). Patients were taking an average of 3.6 (range 1-8; SD=1.7) psychiatric medications at the time of the genetic test, to treat an average of 5 psychiatric conditions (range 1-9; SD=2.2). An average of 1.2 (range 0-4; SD=1.0) gene-drug interactions were uncovered per patient.

Following review by psychiatrist and pharmacist, medication adjustments resulted in patients remaining on an average of 3.6 psychiatric medications, but decreasing the average number of gene-drug interactions per patient to 0.8 (range 0-3, SD=0.8).

Discussion: The large number of genetic variations observed per patient is consistent with previous findings. The decrease in number of gene-drug interactions following testing demonstrates the practical utility of pharmacogenomics information to guide medication therapy. This study did not examine outcomes such as improvement in psychiatric condition or reduction in medication adverse effects; however, these endpoints have been evaluated in other trials.

Conclusions: Pharmacogenomics testing presents an opportunity for a personalized medicine approach in a community-based psychiatry practice.

SECOND PLACE

Comparison of Traditional Therapy Versus Biofeedback for Tension Type and Migraine Headaches: A One Year Retrospective Study of 50 Patients

Ghazala Nathu, MS, MD, PhD, FACB; Adila Nathu, MD, PA, TC (NRCC)

The effectiveness of biofeedback therapy in treating headache has been explored in various clinical settings. However, few studies in the literature focused on well-diagnosed patients who failed properly applied analgesic treatment. The aim of the study is to explore whether the combination of biofeedback and analgesics is more effective than analgesics alone in treating patients with pharmacologically uncontrolled tension type headache and migraine. The hypothesis is that the combination of biofeedback and analgesics is more effective than analgesics alone in treating patients with uncontrolled tension type headache and migraine.

Electromyographic and thermal biofeedback was utilized as an add-on treatment for 25 patients whose tension type headache and migraine was pharmacologically uncontrolled. The effect of the combination therapy was compared with the treatment effect of 25 similar patients, who continued receiving pharmacological treatment alone.

All the subjects from the two groups were randomly selected from the pool of patients with uncontrolled tension type headache and migraine. The progress of two groups was closely monitored and data was collected for statistical analysis, which consists of Chi Square, nonparametric ANOVA, and Mann-Whitney U test.

Some positive results were observed from the group of patients receiving combination therapy of biofeedback and analgesics, including: reduced use of analgesics, reduced muscle tension, reduced pain score, decrease in intensity, frequency, and duration of headache. These positive outcomes were rarely observed from the comparison group, in which pharmacological treatment was continued alone.

The results indicate that the addition of biofeedback to standard analgesic therapy may be more effective than analgesics alone in treating patients with uncontrolled tension type headache and migraine. Further research is suggested to validate these findings and improve treatment effectiveness.

THIRD PLACE

A Marionettist Pulling My Strings: A Case of Buprenorphine-induced Chorea

Dev Patel^{1, 2}; Ishandeep Gandhi¹; Faisal Malek¹; Camille Olechowski³; Alan R. Hirsch, MD²

¹Aureus University School of Medicine, Oranjestad, Aruba; ²Illinois Center for Neurological and Behavioral Medicine, Des Plaines, Illinois; ³Trinity School of Medicine, St. Vincent and The Grenadines

Introduction: Choreaform movements provoked by opiates is an infrequent adverse event. Buprenorphine induction of chorea has not heretofore been described. Such a case is presented.

Method: Case Study: A 38-year-old female presented with a decade long history of alcohol, cocaine, benzodiazepine, and heroin abuse. The patient was insufflating 1.5 grams of heroin daily. On presentation, she was actively withdrawing, scoring 17 on the Clinical Opioid Withdrawal Scale. Urine toxicology screening was positive for opiates, cocaine, and cannabinoids. Buprenorphine 4 mg sublingual was initiated. Within one hour, she observed, “My legs were moving uncontrollably as if I was a marionette.” These dance-like movements were isolated to both legs and gradually resolved after discontinuation of buprenorphine: most of the movements manifested in the first 8 hours, and dissipated over the next 2 days. She did have similar movements after treatment with quetiapine during a previous hospitalization, years earlier.

Results: Abnormalities in physical examination: General: goiter, bilateral palmar erythema. Neurological examination: Cranial Nerve (CN) Examination: CN I: Alcohol Sniff Test: 2 (anosmia). Motor Examination: Drift testing: mild right pronator drift. Reflexes: 3+ bilateral lower extremities. Neuropsychiatric Examination: Clock Drawing Test: 3 (abnormal). Animal Fluency Test: 18 (normal). Go-No-Go Test 6/6 (normal).

Discussion: Buprenorphine-induced chorea could be a result of partial mu-opioid agonism, or kappa and delta receptor antagonism (Burke, 2018; Cowan, 1977). Mu-opioid receptor activation causes increased dopamine turnover in the nigrostriatum, which is responsible for locomotor sensitization (Campos-Jurado, 2017). With the addition of mu-opioid receptor modulation of dopamine release, kappa-opioid receptor alters various neurotransmitters in the basal ganglia, potentiating hyperkinetic movements. Buprenorphine's choreiformogenic action may be due to kappa-opioid receptors ability to augment neurotransmission in the striatum (Escobar, 2017; Bonnet, 1998). The combination of simultaneous activity of these three opioid receptors may cause chorea, since they act to modulate dopamine, glutamate, and GABA in the direct and indirect pathways within the basal ganglia (Abin, 1989; Cui, 2013; Allouche, 2014; Trifilieff, 2013). This patient's history of heroin and cocaine use may have caused supersensitization of dopamine receptors (Memo, 1981), provoking hyperkinesia. Involvement of substance-induced sensitization with concurrent kappa-opioid receptor neurotransmitter augmentation in direct and indirect pathways in the basal ganglia may have primed our patient to the development of chorea after buprenorphine administration. Further investigation for the presence of extrapyramidal movements in those undergoing buprenorphine treatment is warranted.

Share, disseminate, and promote your accomplishments and contributions to the field at the 2020 NEI Congress Scientific Poster Session and Reception!

Submission deadline: August 10, 2020
Poster session: November 7, 2020

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2019 NEI Congress Young Investigator Poster Competition Winners

November 10, 2019