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Master Thesis

Pharmacorésistance aux psychotropes et anomalies pharmacogénétiques du cytochrome P4502D6 : vers une médecine personnalisée en pédopsychiatrie. Étude biomédicale interventionnelle prospective multicentrique

Abstract : Serious mental disorders in children and adolescents ; such as schizophrenia, bipolarity or depression are chronic disabling conditions that represent a significant public health issue. Despite adequate drug treatment, some patients have pharmacoresistance and therefore often polytherapy, exposing them to side effects, and longer drug taking.
Psychotropic drugs are predominantly metabolized in the liver by CYP2D6 subunit of cytochrome P450. A functional abnormality of this subunit results in a disorder of the metabolization of these treatments (inefficiency or side effects). We set up a multicenter biomedical study "M4P" whose objective is to study the prevalence of CYP2D6 duplications or polymorphisms associated with an Ultra Fast Metabolic (UFM) phenotype in drug-resistant children and adolescents with psychotropic drugs. The presence of UFM phenotype concerns one patient (4.5%) in our study.
This prevalence is therefore lower than we observed in a preliminary study (33%) and that in the general population in southern Europe (10%). Therefore, these results do not allow us to conclude on the presence of a link between drug resistance to psychotropic drugs and abnormality type duplication of CYP2D6. The analysis of the results on secondary objectives allows us to characterize the population of drug-resistant patients whose severity and impact of their pathology are major, long-term care, multiple prescriptions and numerous side effects.
The clinical presentation of a teenager nevertheless illustrates the individual benefit after therapeutic rehabilitation in the event of a pharmacogenetic anomaly. Without losing sight of the fact that the pharmacological approach is obviously not enough, this work questions the contribution of personalized medicine in child psychiatry and paves the way for other research projects to better understand the drug resistance of our patients, question how we respond to it and possibly prevent it.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02381804
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Submitted on : Tuesday, November 26, 2019 - 6:21:23 PM
Last modification on : Sunday, October 25, 2020 - 7:05:47 AM

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Alexia Provenzani-David. Pharmacorésistance aux psychotropes et anomalies pharmacogénétiques du cytochrome P4502D6 : vers une médecine personnalisée en pédopsychiatrie. Étude biomédicale interventionnelle prospective multicentrique. Médecine humaine et pathologie. 2019. ⟨dumas-02381804⟩

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