Table of Contents - Academy of Psychosomatic Medicine

Oral Presentations
Saturday, November 14, 2009
10:00 AM – 12:00 PM
GROUP A
1. 2008 Webb Fellow: Gene X Environment
Interaction in Psychosomatic Medicine
Presenting Author: Gen Shinozaki, MD
Purpose. There is increasing interest and research related
to gene x environment interactions in patients with conditions
treated by Psychosomatic Medicine psychiatrists. The
gene x environment interaction is uniquely important at the
interface between psychiatric and medical illnesses (e.g.
depression in cancer patients) and when somatic symptoms
are influenced by psychological trauma (e.g. increased body
mass index (BMI) or heart rate (HR) associated with child
abuse history, (1, 2)). Stressful life events, such as remote
history of child abuse, are associated with higher prevalence
of depression and other psychiatric characteristic such as
suicidal attempt (2). Similarly to such environmental factors,
genetic factors play roles in the development and presentation
of primary psychiatric disorders. Child abuse history and
serotonin transporter gene promoter polymorphism (5HTTL-
PR) status are related in interactive ways with the probability
of depression (4). It was hypothesized that the reported association
between BMI, HR, and child abuse history could be
modulated by 5HTTLPR status in a similar manner. The aim
of this study was to investigate the influence of this hypothesized
interaction on the psychiatric characteristics, physiological
measures (e.g., HR, BMI), and medical comorbidities
(e.g., diabetes mellitus prevalence) among depressed
psychiatric inpatients.
Methods. Retrospective chart review was conducted on 185
Caucasian female patients hospitalized for depression on the
Mayo Clinic Mood Disorders Unit from 2005-2007 who were
also genotyped for 5HTTLPR. We focused on this population
in order to avoid confounding ethnic genotype stratification
issues and gender differences in physiological and
metabolic profiles. Patients’ medical and psychiatric characteristics
were recorded, including past child abuse history
(physical, sexual, or emotional), current psychiatric diagnosis
(including personality disorder), past suicide attempt history,
resting HR on admission, BMI, fasting glucose level, and
chronic medical diagnoses. The subjects were divided into 2
groups, 1) long/long (l/l) genotype, and 2) any short genotype—i.e.,
short/short (s/s) and short/long (s/l) genotypes
combined. Each genotype group was further divided into two
sub-groups based on the history of child abuse for statistical
analysis, and for each characteristic, Fisher’s Exact Tests
were used to analyze categorical data. T-tests were used for
continuous data. Level of statistical significance was set at
0.05 though trends are reported.
Results. 98 patients (53.0%) had child abuse history. We
found that, among patients with the l/l genotype, patients
37
with abuse history had a higher rate of past suicide attempts
(71% versus 29%, p=0.0010), higher average heart rate on
admission (83.2 bpm versus 73.6 bpm, p=0.013), higher
prevalence of diabetes (14.3% versus 0%, p=0.06), and
higher BMI (32.3kg/m 2 versus 27.3kg/m 2 , p=0.031). Patients
with the short allele (s/s or s/l) did not have significant differences
based on abuse history on study measures.
Conclusions. The interaction between the l/l 5HTTLPR
genotype and abuse history in these inpatients was associated
with past suicide attempts, faster heart rate, a trend
toward higher prevalence of diabetes, and higher BMI--in the
obesity range. Contrary to the widely recognized “reactivity”
associated with the short allele of 5HTTLPR, our Caucasian
female depressed psychiatric inpatients with the l/l genotype
showed distinct clinical pathology compared with other 5HT-
TLPR genotype groups when there was a history of child
abuse. Potential reasons for this seeming paradox will be
discussed.
References.
1. Heim C, Newport DJ, Heit S, Graham YP, Wilcox M, Bonsall
R, Miller AH, Nemeroff CB., Pituitary-adrenal and autonomic
responses to stress in women after sexual and physical
abuse in childhood., JAMA. 2000 Aug 2;284(5):592-7.
2. Gilbert R, Widom CS, Browne K, Fergusson D, Webb E,
Janson S., Burden and consequences of child maltreatment
in high-income countries., Lancet. 2009 Jan 3;373(9657):68-
81.
Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington
H, McClay J, Mill J, Martin J, Braithwaite A, Poulton R. Influence
of life stress on depression: moderation by a polymorphism
in the 5-HTT gene. Science. 2003;301:386-389.
2. 2008 Webb Fellow: Exploring Providers
Decisions about Delaying or Suspending
Antiretorviral Therapy
Presenting Author: Christopher Kogut, MD
Purpose: For antiretroviral (ARV) medications to successfully
suppress the HIV virus and avoid contributing to viral
resistance, patients must maintain strict adherence with their
treatment regimens. Despite a growing literature on predictors
of adherence to ARVs, the literature has not addressed
how practitioners make decisions about when therapy is appropriate
when impeding factors are present. The goal of
this pilot study is to elucidate which factors are most important
to practitioners in determining when to delay the initiation
of ARV or suspend ARV.
Methodology: An exploratory online survey was constructed
and distributed to a sample of local primary HIV providers
as well as to psychiatrists with a specific interest in HIV psychiatry.
Providers were asked to rate the importance of various
factors in their decisions to either delay or suspend ARV
therapy. They were also asked to rate their level of comfort
with a variety of clinical scenarios.
Results: 37 providers completed the survey. 78% of providers
had delayed ARVs and 65% had suspended ARVs
when there were psychosocial impediments to adherence.