Special Lecture(SL)

  1. Special Lecture(SL)
  2. Joint Symposium(JS)
  3. Symposium(S)
  4. CNP Paul Janssen Awards(PJ)
  5. Prize for Encouragement of the society(EN)
  6. Luncheon Seminar(LS)
  7. Sponsored Symposium(SS)
  8. Oral Presentations(O)
  9. Poster Presentations(P)

LS1-3

Dopamine and Antipsychotics: Past, Present and Future

Shitij Kapur

  1. the Dean, Faculty of Medicine, Dentistry and Health Sciences and Assistant Vice-Chancellor( Health), University of Melbourne. Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne

Antipsychotics were discovered by serendipity in 1952. The discovery of antipsychotics led to a profusion of theories of action, and how the true mechanism was nailed in 1976 with the identification of dopamine receptors. Subsequent research demonstrated that it was not any dopamine receptor subtype, but specifically the dopamine D2 receptor that was critical for antipsychotic response. Since then, thousands of compounds have been screened for antipsychotic activity. All the new antipsychotics that have been clinically successful have activity on the dopamine D2 receptor family - though they also act on other receptors that may be acting as modifiers or may be adding to side effects. However, finding antipsychotics that go beyond the dopamine D2 receptor has been unsuccessful. Even action close to the D2 receptor family (on the D1 and D4 receptor) has not as yet been successful. Conversely, genetics driven efforts have highlighted a very large number of genes with very modest effect sizes, and do not naturally land on the dopamine D2 receptor. However, PET studies have given a much better understanding of why antipsychotics work - but suggest that we are targeting the wrong end of the dopamine system. In this last decade, three lines of thinking are driving drug discovery. Those that understand the action of dopamine receptors and try to replicate it mechanistically via a different mechanism (e.g. PDE10 inhibitors, A2A agonists); those that bypass the dopamine receptor altogether (e.g. mGLu II/III) to treat psychosis; and those that focus on the negative/cognitive [as opposed to psychotic] symptoms of schizophrenia (e.g. GlyT1 inhibitors, alpha-Nic-7). These new trials have engendered hope and excitement - however some of the early results have been disappointing. The talk will trace this sixty year journey to date and will identify some light at the end of the tunnel.

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LS2-1

Early Intervention in the Diagnosis and Treatment of Bipolar Disorder and Schizophrenia

Joseph R. Calabrese

  1. The Bipolar Disorders Research Chair, the Bipolar Disorders Research Centre, the Mood Disorders Program at Case Western Reserve University School of Medicine in Cleveland, Ohio

Disciplines associated with the practice of medicine aspire to target early intervention in the diagnosis and treatment of serious illness. By doing so, the prospects of achieving full and complete recoveries have increased. Over the past five years the advances made in the pharmacotherapy and behavioral management of serious mental illness have been nothing less than extraordinarily remarkable. Our discipline is moving towards the practice of psychiatry such that clinicians are beginning to target the diagnosis and treatment of patients who are still in the prodromal of their illness. Rather than waiting for patients to exhibit treatment refractory syndromal signs and symptoms, the field is moving towards the prospect of early interventions that possess efficacy in the treatment of subsyndromal symptoms. Coincident this these developments, there appears to have been an explosion of new pharmacotherapeutic medications that appear to possess a broader spectrum of efficacy. Over recent years we have observed that most of the new medications appear to have a broader spectrum of efficacy which appear to be resulting in fuller and more complete recoveries. In addition to our new insights regarding the importance of compounds with a broader spectrum of efficacy, there is emerging consensus that these new compounds may also possess efficacy in the treatment of patients presenting with subsyndromal signs. This explosion of new psychotropic medications will continue improve our current state-of-the-art.

As a recent example of the importance of early intervention, findings reported in the most recent issue of the American Journal of Psychiatry by Marie Starzer, MD and colleagues have studied the rates and predictors of conversion to Schizophrenia or Bipolar Disorder following substance-induced psychosis (2018;175:343-350). These investigators have identified findings that elucidate the rates and predictors of conversion to schizophrenia or bipolar disorder following substance-induced psychosis. The time has come for the field to identify and target early interventions that have the potential of achieving full and complete recoveries early during the prodrome of the mental disorders.

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  1. Special Lecture(SL)
  2. Joint Symposium(JS)
  3. Symposium(S)
  4. CNP Paul Janssen Awards(PJ)
  5. Prize for Encouragement of the society(EN)
  6. Luncheon Seminar(LS)
  7. Sponsored Symposium(SS)
  8. Oral Presentations(O)
  9. Poster Presentations(P)