Utility of pharmacogenetic testing to optimise antidepressant pharmacotherapy in youth: a narrative literature review.

Pharmacogenetics (PGx) is the study and application of how interindividual differences in our genomes can influence drug responses. By evaluating individuals' genetic variability in genes related to drug metabolism, PGx testing has the capabilities to individualise primary care and build a safer drug prescription model than the current "one-size-fits-all" approach. In particular, the use of PGx testing in psychiatry has shown promising evidence in improving drug efficacy as well as reducing toxicity and adverse drug reactions. Despite randomised controlled trials demonstrating an evidence base for its use, there are still numerous barriers impeding its implementation. This review paper will discuss the management of mental health conditions with PGx-guided treatment with a strong focus on youth mental illness. PGx testing in clinical practice, the concerns for its implementation in youth psychiatry, and some of the barriers inhibiting its integration in clinical healthcare will also be discussed. Overall, this paper provides a comprehensive review of the current state of knowledge and application for PGx in psychiatry and summarises the capabilities of genetic information to personalising medicine for the treatment of mental ill-health in youth.

Outcomes of brief versions of Dialectical Behaviour Therapy for diagnostically heterogeneous groups in a routine care setting.

INTRODUCTION: Brief versions of Dialectical Behaviour Therapy (DBT) may enhance patient outcomes in diverse service settings. This study examined the effectiveness of two DBT-informed treatments for diagnostically heterogeneous groups in routine practice: 5-day group training in DBT skills (DBT-5) and a 12-week DBT program (DBT-12). METHODS: : Depression, anxiety, stress, borderline symptoms, self-esteem, and general mental wellbeing were measured at pre-and post-treatment in a sample of inpatients and outpatients (N=395). Rates of clinically significant change on these measures were calculated and effect sizes benchmarked against prior DBT outcome studies. Readmission rates were used to measure treatment response maintenance. RESULTS: : Scores on all measures improved significantly from pre- to post-treatment. DBT-5 and DBT-12 yielded similar effect sizes compared to prior DBT outcome studies. At least 43.5% of patients were classified as recovered or improved regarding borderline symptoms at the end of both DBT-5 and DBT-12. Readmission rates were also low (5%-6.8%). CONCLUSIONS: Brief DBT-informed treatments may offer a fast reduction in symptoms and quicker return to functioning.

Experimentally-enhanced perceptions of meaning confer resilience to the interpersonal adversity implicated in suicide risk.

BACKGROUND AND OBJECTIVES: The interpersonal theory of suicide proposes that perceived burdensomeness and thwarted belongingness (PB-TB) are proximal causes of suicidal desire. Here we test whether experimentally induced perceptions of meaningfulness can confer resilience against interpersonal adversity and enhance persistence, the erosion of which is a potential antecedent to suicide risk. METHODS: Undergraduate university students (N = 93) were randomly allocated to complete a team task under conditions of high or low task-extrinsic meaning and high or low PB-TB. Participants in the high task-extrinsic meaning condition were given the opportunity to donate to a charity as part of their experimental participation, whereas those in the low task-extrinsic meaning condition were not. RESULTS: Consistent with the buffering hypothesis that suicide resilience is active only when adversity is heightened, participants in the high task-extrinsic meaning condition who reported higher levels of perceived meaningfulness displayed greater willingness to persist in the face of experimentally-induced high PB and TB compared to those in the low task-extrinsic meaning condition and those in conditions where the interpersonal adversity was not induced (low PB and TB). LIMITATIONS: The meaning induction was effective only in a subset of participants. The dual induction of PB and TB also precludes inferences about their independent causal effects on willingness to persist. CONCLUSIONS: Meaning-making interventions may attenuate the impact of proximal interpersonal antecedents of suicidal desire. Enhancing resilience in this manner can potentially improve the efficacy of prevention efforts beyond the direct amelioration of suicide risk factors.

Mind full of life: Does mindfulness confer resilience to suicide by increasing zest for life?

BACKGROUND: Mindfulness is a trainable skill that may enhance resilience to suicidality among vulnerable groups such as young people. The current study examined whether mindfulness protects against suicidal desire in the face of heightened risk and adversity by increasing zest for life in a sample of university students. METHODS: In a prospective design, participants (N = 233) were assessed at two time points over eight weeks. Online surveys included the Mindful Attention and Awareness Scale, Zest for Life Scale, Interpersonal Needs Questionnaire, Kessler Psychological Distress Scale, and items assessing suicidal ideation and suicidal intent. RESULTS: Baseline mindfulness was associated with lower suicidal ideation and intent at follow-up. Moderated mediation analyses confirmed the effects of mindfulness on ideation and intent were mediated by zest for life and these indirect effects were stronger at higher versus lower levels of general (psychological distress) and suicide-specific (perceived burdensomeness and thwarted belongingness) risk. LIMITATIONS: Single item assessments of suicidal desire. CONCLUSIONS: Findings suggest that mindfulness protects against suicidal desire in conditions of heightened risk and adversity by enhancing one's orientation towards a life worth living. Theories of suicide should consider the dynamic interplay between risk and life-sustaining resilience, while clinicians treating suicidality could use mindfulness strategies to strengthen the desire to (re)engage with life, thereby complementing direct amelioration of suicide risk factors.

Mindfulness and zest for life buffer the negative effects of experimentally-induced perceived burdensomeness and thwarted belongingness: Implications for theories of suicide.

Suicide research can be enhanced by an ability to safely manipulate putative causal variables. The present studies developed an experimental task to modify risk factors identified by the interpersonal theory of suicide (perceived burdensomeness and thwarted belongingness) and examine their hypothesized suppressive effect on persistence in adversity in undergraduate university students. Variables that may moderate the impact of these risk factors on persistence (zest for life and mindful awareness) were incorporated as potential resilience factors. Study 1 (N = 92) found elevated burdensomeness and diminished belongingness significantly impaired persistence. Additionally, these predicted effects were moderated by individual differences in zest for life. In Study 2 (N = 52), individuals trained in mindfulness prior to the experimental task displayed greater persistence relative to controls. Findings provide experimental support for the role of perceived burdensomeness and thwarted belongingness in the manner predicted by the interpersonal theory, and demonstrate a way to experimentally test the effects of resilience factors that reduce the impact of these interpersonal factors. (PsycINFO Database Record

Achieving Millennium Development Goals 4 and 5 in Pakistan.

Pakistan is a signatory of many international development strategies including the Millennium Development Goals, and the government is committed to achieving a reduction in infant mortality rate from 72 to <55 per 1000 live births, the newborn mortality rate from 55 to <40 per 1000 live births and the maternal mortality rate from 276 per 100,000 to 140 per 100,000 live births by 2015. Maternal, newborn and child health play a key role in reducing poverty and promoting social and economic development. Improvement in maternal and child health is a priority agenda of the Government of Pakistan.

FIGO Save the Mothers Initiative: the Pakistan-UK collaboration.

The pilot study in Punjab, Pakistan was one of the five paired demonstration projects sponsored by FIGO in the "Save the Mothers" maternal mortality project. The goal of the project was to bring basic and comprehensive emergency obstetric care (EmOC) to a semiurban and rural area some 30 km from Lahore, where effectively there was none. The aim was to achieve this by using the existing facilities within the rural health system without the deployment of extra specialist staff other than as initial facilitators. This report shows trebling of some performance indicators and an improvement in met need. There is coincidentally a similar increase in the uptake of general medical services. Reducing maternal mortality requires building local capacity for EmOC; the essential components being the premises, trained personnel, equipment, and availability of drugs and blood. Availability and provision of EmOC coupled with changes in the attitude of the population resulted in marked improvement of process indicators.