On Demand Grand Rounds: The Future of Pediatric Psychopharmacology: Insights from Pediatric Psychosis and the Genome
This presentation was originally reviewed on May 4, 2020, and broadcast live online on May 6, 2020, from 12:00 PM - 1:00 PM ET.
The views and opinions expressed by this presenter in this lecture are their own, and do not represent the views of Sheppard Pratt.
In child psychiatry, our goal is to return a patient to the path that their development would take absent pathological processes that derail that development. The state of that endeavor is that we have fairly good success with mild to moderate disorders such as ADHD and anxiety disorders, but for severe psychiatric disorders such as schizophrenia, we have not. Despite our best efforts, the majority of patients with schizophrenia remain disabled. Treatment development has been hampered by lack of knowledge of the cause and how it works. Our technologies to-date have not brought an understanding of the actual diseases our patients face or how they come about.
Now the cost of sequencing our patients’ human genome is down to less than $1,000 and the technology and databases to interpret our patients’ genetic sequences are increasingly powerful. This enables us to detect much more genetic variation that is highly penetrant in causing psychiatric disease than we could before. We are able to transform patient blood cells to stem cells to neurons and glia in culture such that when we find a strong genetic cause we can start to model the resulting disease in a dish. This model might be used to screen for treatments.
This presentation will review some of the emerging understanding of the contributions of common and rare genetic variation. I will try to illustrate, through examples, a discovery cycle that starts with the patient with early onset psychosis, through identification of rare genetic variants that might be causal in that patient, modeling of the patient’s disorder with induced pluripotent stem cell derived brain cells, and in mouse models and how we hope this will lead to transformative treatments. This process should also be followed for very early onset forms of other psychiatric disorders.
This activity is intended for physicians, nurses, psychologists, social workers, counselors and other mental health professionals.
At the conclusion of this activity, attendees will be able to:
1. Describe the concepts of heterogeneity, pleiotropy, penetrance, and variable expressivity in regards to the genetics of severe very early onset psychopathology.
2. Identify the extreme bookends of recent genetic debate about genetic causation for schizophrenia and other serious mental disorders starting with the “Common Disease/ Common Variant Hypothesis” as it applies to findings in psychiatric genetics.
3. Discuss the other extreme bookmark of current psychiatric genetics debate the “Common Disease/Rare Variant” hypothesis of genetic causation in psychiatry and how it might lead to new treatments.
Sheppard Pratt’s Professional Education Program is pleased to provide Wednesdays at Sheppard Pratt free of charge as a public service to the mental health community. Your tax-deductible donations will help maintain the outstanding quality of this service.
Sheppard Pratt is dedicated to improving quality of life through mental health, special education, and addiction services for children, adolescents, adults and older adults. Our patient-centered treatment approach, combined with our legacy of clinical excellence, sets us apart from other health systems on both a local and national level. We have been ranked among the nation’s top psychiatric hospitals for 24 consecutive years by U. S. News & World Report. Founded in 1853 by philanthropist Moses Sheppard, Sheppard Pratt Health System still abides by its Quaker traditions and values.
Sheppard Pratt regularly hosts renowned speakers from across the country at our headquarters in Towson. We provide educational opportunities on subjects including psychiatric disorders, issues of behavioral health, systems-based change, mental and somatic co-morbidities, psychiatric effects on health and health outcomes, advances in neurobiology, and clinical developments in concepts underlying drug treatment of psychiatric disorders. We are accredited by the Accreditation Council of Continuing Medical Education, the Maryland Nurses’ Association, the Maryland Board of Psychology, the Maryland Board of Social Work, and the National Board of Certified Counselors.
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About The Speaker
Joseph Gonzalez-Heydrich, MD is Director of the Developmental Neuropsychiatry Clinic at Boston Children’s Hospital and an Associate Professor of Psychiatry at the Harvard Medical School. His research aims to treat children with severe psychiatric disorders. He has helped develop computer applications to help them develop stronger emotional regulation, has worked to develop psychiatric clinical trial designed to include children with neurological disorders, and has uncovered rare genetic mutations leading to schizophrenia and very early onset psychotic disorders. Describing his work, he writes, “I daily come up against the limits of our art. However, I have never felt those limits more poignantly than since concentrating my practice on children with very early onset very severe psychiatric disorders. For too many of these children, their families and clinicians, the observing the process of treatment has been like watching a train wreck in slow motion with an unseen hand at the controls pushing the train inexorably towards catastrophe despite the best treatments available. However, now my work is energized as never before by the new opportunities presented by this unique point in human medical history. We can now sequence patients’ genomes and grow neurons from their blood cells. In this way we are finding the biological mechanisms that make some children particularly vulnerable to environmental stress and can develop new treatments. These new techniques have seemed to me like magic dust that makes the unseen hand visible and has raised the hope that in partnership with families, scientists, and community leaders transformative new treatments can be developed to pry its fingers from the controls and truly treat or even prevent severe psychiatric illnesses.”
Sheppard Pratt holds the standard that its continuing medical education programs should be free of commercial bias and conflict of interest. In accord with Sheppard Pratt's Disclosure Policy, as well as standards of the Accreditation Council for Continuing Medical Education (ACCME) and the American Medical Association (AMA), all planners, reviewers, speakers and persons in control of content have been asked to disclose any relationship he /she (or a partner or spouse) has with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 12 months. All planners, reviewers and speakers have also been asked to disclose any payments accepted for this lecture from any entity besides Sheppard Pratt Health System, and if there will be discussion of any products, services or off-label uses of product(s) during this presentation.
Joseph Gonzalez-Heydrich, MD reports having equity in Mightier/Neuromotion Labs as the Founder, and Founding Chair of Scientific Advisory Council, and as a consultant for clinical trial design for Alkermes Pharmaceuticals, during the past 12 months. He will discuss case studies with the administered medications included and medications prescribed earlier than the approved FDA age in this presentation.
Event Planners/Reviewers Disclosures: The following event planners and/or reviewers are reported as having no financial interest, arrangement or affiliation with any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 12 months: Todd Peters, MD, Deepak Prabhakar, MD, Briana Riemer, MD, Louis Marino, MD, Ehsan Syed, MD, Devi Bhuyan, PhD, Faith Dickerson, PhD, Carrie Etheridge, LCSW-C, Tom Flis, LCPC, Laura Webb, RN-BC, MSN, Bruce Boxer, PhD, MBA, MA, MSN, RN, NPD-BC, NEA-BC, MCHES, CPHQ, Stacey Garnett, RN, MSN, Heather Billings, RN, and Jennifer Tornabene.
Physician Statement: Sheppard Pratt is accredited by The Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. Sheppard Pratt designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurse Statement: Sheppard Pratt is approved as a provider of nursing continuing professional development by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. This activity provides 1.0 contact hours for nurses.
Psychologist Statement: Sheppard Pratt is authorized by the State Board of Examiners of Psychologists as a sponsor of continuing education. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. Sheppard Pratt designates this educational activity for a maximum of 1.0 contact hours for Psychologists.
Social Worker Statement: Sheppard Pratt is authorized by the Board of Social Work Examiners of Maryland to offer continuing education for Social Workers. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. This activity is approved for 1.0 contact hours in Category II credits for Social Workers.
Counselor Statement: Sheppard Pratt has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5098. Programs that do not qualify for NBCC credit are clearly identified. Sheppard Pratt is solely responsible for all aspects of the program. This activity is available for 1.0 NBCC clock hours.
- 1.00 ACEP NBCC clock hours
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Category II credits for Social Workers
- 1.00 Psychologists
- 1.00 MNA Contact Hours for Nurses
- 1.00 Participation
ON DEMAND WEBINAR: FOR BEST RESULTS WATCH USING GOOGLE CHROME
Grand Rounds: Addressing the Demand for Pediatric Mental Health Care
Joseph Gonzalez-Heydrich, MD
Associate Professor of Psychiatry
Harvard Medical School
Originally reviewed May 4, 2020.
Originally broadcast live May 6, 2020, from 12:00 noon - 1:00 pm EST
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