Medscape Special Session Coverage on the 2008 American Psychiatric Association Annual Meeting: May 5, 2008

Andrew N. Wilner, MD, FAAN, FACP


May 06, 2008

In This Article

New Approaches to Psychiatric Disease Mechanisms

C. Thomas Caskey, MD, FACP, Director and Chief Executive Officer of the Brown Foundation Institute of Molecular Medicine, University of Texas, Houston, provided an overview of emerging technologies that have transformed several areas of medicine. Advances in genetics, in particular, are beginning to influence the way that we diagnose and treat disease.[5]

"The Human Genome Project is the greatest biologic project of the century. It will direct science for the next 100 years to gain understanding of how genes work in a coordinated manner to create life and our differences," observed Dr. Caskey.

Genetic discoveries have resulted in "disruptive impact" in the modern understanding of several diseases. For example, 5 genes have been identified that contribute to the development of type 2 diabetes, defined as insulin insensitivity: MODY, CAPNIO, PPARG, KCNJII, and TCF7L2. Dr. Caskey stressed that type 2 diabetes is not a single disease. "Diabetes," he offered, "is multiple diseases that will require different treatments."

The identification of HER-2 (human epidermal growth factor-2) receptors in approximately 10% of cases of breast cancers has influenced breast cancer management. These receptors drive rapid growth of cells, and specific treatment can be given for HER-2-positive patients. Dr. Caskey emphasized that it is important to recognize that a specific treatment for breast cancer, such as one directed at HER-2 receptors, might be missed if the whole population of breast cancer were studied, because this type of breast cancer occurs only in a minority of patients. Clinical trials for new drugs must be designed with the idea of subpopulations in mind.

Dr. Caskey concluded that as we learn more about the genetic basis of affective disorders such as autism, schizophrenia, and bipolar disease, more specific treatments may be developed. Genetic differences such as chromosomal number variation, single nucleotide polymorphisms, epigenetic gene regulation, and metabolic markers are all new tools that will help differentiate diagnostic subtypes.

"Matching the therapeutic to a diagnostic is important for effective treatment," concluded Dr. Caskey.


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