2 results
Suicidal thoughts/acts and clinical correlates in patients with depressive disorders in Asians: results from the REAP-AD study
- Seon-Cheol Park, Min-Soo Lee, Sang Woo Hahn, Tian-Mei Si, Shigenobu Kanba, Mian-Yoon Chong, Chee Kok Yoon, Pichet Udomratn, Adarsh Tripathi, Norman Sartorius, Naotaka Shinfuku, Margarita M. Maramis, Yong Chon Park
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- Journal:
- Acta Neuropsychiatrica / Volume 28 / Issue 6 / December 2016
- Published online by Cambridge University Press:
- 16 June 2016, pp. 337-345
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- Article
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Objective
Using data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants (REAP-AD) study, we aimed to present the rates and clinical correlates of suicidal thoughts/acts in patients recruited from a total of 40 centres in 10 Asian countries/areas: China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Singapore, Taiwan, and Thailand.
MethodsData from 1122 patients with depressive disorders in the REAP-AD study were used. The ICD-10 was employed to diagnose depressive episodes and recurrent depressive disorder. The presence or absence of suicidal thoughts/acts and profile of other depressive symptoms was established using the National Institute for Health and Clinical Excellence guidelines for depression. Country/area differences in rates of suicidal thoughts/acts were evaluated with the χ2 test. In addition, depressive symptom profiles, other clinical characteristics, and patterns of psychotropic drug prescription in depressed patients with and without suicidal thoughts/acts were compared using analysis of covariance for continuous variables and logistic regression analysis for discrete variables to adjust the effects of covariates.
ResultsThe rates of suicidal thoughts/acts in 10 countries/areas varied from 12.8% in Japan to 36.3% in China. Patients with suicidal thoughts/acts presented more persistent sadness (adjusted odds ratio [aOR]=2.64, p<0.001), loss of interest (aOR=2.33, p<0.001), fatigue (aOR=1.58, p<0.001), insomnia (aOR=1.74, p<0.001), poor concentration (aOR=1.88, p<0.001), low self-confidence (aOR=1.78, p<0.001), poor appetite (aOR=2.27, p<0.001), guilt/self-blame (aOR=3.03, p<0.001), and use of mood stabilisers (aOR=1.79, p<0.001) than those without suicidal thoughts/acts.
ConclusionSuicidal thoughts/acts can indicate greater severity of depression, and are associated with a poorer response to antidepressants and increased burden of illness. Hence, suicidal thoughts/acts can provide a clinical index reflecting the clinical status of depressive disorders in Asians.
5 - Pharmacogenetics of ethnic populations
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- By Min-Soo Lee, Department of Psychiatry, Korea University College of Medicine, Seoul, Korea, Rhee-Hun Kang, Department of Psychiatry, College of Medicine, Korea University, Seoul, Korea, Sang-Woo Hahn, Department of Psychiatry, College of Medicine, Soonchunhyang University, Seoul, Korea
- Edited by Chee H. Ng, University of Melbourne, Keh-Ming Lin, Bruce S. Singh, University of Melbourne, Edmond Y. K. Chiu, University of Melbourne
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- Book:
- Ethno-psychopharmacology
- Published online:
- 22 August 2009
- Print publication:
- 20 March 2008, pp 62-86
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Summary
Introduction
Highly complex mechanisms underlie the variability in drug responses, which can be attributed to several physiological and environmental factors such as age, renal and liver function, nutritional status, smoking, and alcohol consumption. However, it has been established for almost half a century that genetic factors also influence both the efficacy of a drug and the likelihood of adverse reactions (Weinshilboum, 2003). Psychotropic drugs appear to be effective across cultures and ethnicities (Lin, Poland & Nakasaki, 1993, Lin, Tsai, Yu et al. 1999), but it is increasingly recognized that these responses also vary (Lin & Poland, 1995; Poolsup, Li Wan Po & Knight 2000). The discovery of widespread ethnospecific polymorphisms in genes governing pharmacokinetic and pharmacodynamic aspects of psychotropic drugs may explain some of these variations (Lin et al., 1999; Kalow, 1992).
Pharmacodynamic aspects
The term pharmacodynamics encompasses all the processes that influence the relationship between drug concentration and resulting effects. Psychotropic drugs have a wide variety of targets within neurotransmitter systems, including neurotransmitter synthesis, degradation of enzymes, storage, receptors, and specific transporter proteins.
Genetic studies of antidepressants
Serotonin transporter
The brain 5-HT transporter (5-HTT) is the principal site of action of many antidepressants. This transporter takes up 5-HT into the presynaptic neuron, thus terminating synaptic actions, and recycles it into the neurotransmitter pool. Ramamoorthy, Bauman, Moore et al. (1993) identified and cloned a single gene encoding the human 5-HTT, localized to chromosome 17q11.1∼q12, spanning 21 kb, and consisting of 14 exons (Lesch, Balling, Gross et al., 1994).