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Psyber Psychiatry, Commentary


A prescription to improve drug regimens?

Quantitative EEG, genetic testing can help psychiatrists choose the right psychotropic.

Vol. 4, No. 8 / August 2005

One day we may be able to consistently choose medications that offer optimal benefit and minimal adverse events—without subjecting our patients to unsuccessful trials. Thanks to quantitative EEG (OEEG) testing and pharmacogenetic testing, that day may be coming closer.

How quantitative eeg works

QEEG adds modern computer and statistical analyses to traditional EEG recordings. The computer creates a graphic display on a schematic map of the head. The procedure is often called brain electrical activity mapping (BEAM) or simply “mapping.” New tool: Genotyping makes prescribing safer, more effective, Current Psychiatry, September 2004.) Physicians can order any combination of gene tests, which cost about $150 to $200 each, or all available tests for a discounted price of approximately $600.

Genelex and Signature Genetics can create individualized CYP-450 function reports to facilitate prescribing and customized reports that take into account the patient’s medication and diet regimen. Genelex also offers an Internet-based software tool, GeneMedRx, which allows doctors to customize medication regimens based on both potential drug-drug interactions and genomic information.

Signature Genetics offers a prospective assessment of drugs based on genetic test results. This assessment provides a comprehensive report of which medications are affected by the test results.

Genetic profiling can help psychiatrists improve the likelihood of treatment success and minimize potential drug-drug interactions and adverse reactions. Patients will be more satisfied, knowing that their medications fit their individual needs. Also, as more is learned about genetic analysis, genetic testing could one day reveal susceptibility to Alzheimer’s disease, heart attack risk, or other medical problems.

As with quantitative EEG, however, few insurance companies cover genetic testing. Also, patients found to have a higher likelihood of developing certain diseases could potentially be charged higher health insurance premiums.

Related resources

Indiana University School of Medicine. Drug interactions table. medicine.iupui.edu/flockhart/clinlist.htm

Luo J. Psyber Psychiatry. Prescribing Information: scroll with the changes (online, handheld resources on drug-drug interaction, medications’ effect on CYP-450 system. Current Psychiatry 2003;2(8 online edition). www.currentpsychiatry.com/article_pages.asp

Disclosure

Dr. Luo reports no financial relationship with any company whose products are mentioned in this article. The opinions expressed by Dr. Luo in this column are his own and do not necessarily reflect those of Current Psychiatry.

References (accessed July 27, 2005)

1. Children’s Hospital Boston. Child Health A to Z. What is qEEG? Available at: http://www.childrenshospital.org/cfapps/A2ZtopicDisplay.cfm?Topic=Quan titative%20EEG

2. UCLA Quantitative EEG Laboratory. QEEG Cordance. Available at: http://www.qeeg.npi.ucla.edu/cordance/

3. Cook IA, Leuchter AF, Witte E, et al. Neurophysiologic predictors of treatment response to fluoxetine in major depression. Psychiatry Res 1999;85:263-73.

4. Cook IA, Leuchter AF, Morgan M, et al. Early changes in prefrontal activity characterize clinical responders to antidepressants. Neuropsychopharmacology 2002;27:120-31.

5. Song DH, Shin DW, Jon DI, Ha EH. Effects of methylphenidate on quantitative EEG of boys with attention-deficit hyperactivity disorder in continuous performance test. Yonsei Med J 2005;46:34-41.

6. Nuwer M. Assessment of digital EEG, quantitative EEG, and EEG brain mapping: report of the American Academy of Neurology and the American Clinical Neurophysiology Society. Neurology 1997;49:277-92.

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