<p>Genetically determined differences in drug metabolism and disposition and drug targets play a pivotal role in the interindividual variability in the clinical outcome of antipsychotic treatment. The aim of this thesis was to study the impact of polymorphisms in genes involved in the pharmacokinetics and pharmacodynamics of antipsychotics, with special focus on their extrapyramidal and metabolic adverse effects. </p><p>Polymorphisms in serotonin 2A and 2C receptor coding genes (<i>HTR2A</i> and <i>HTR2C</i>) were found to be associated with the risk to develop extrapyramidal side effects (EPS) in patients on short term perphenazine treatment. A further study in a larger group of patients on long term treatment with various classical antipsychotics confirmed the association between occurrence of EPS and <i>HTR2C</i> polymorphisms. In another study, dose corrected steady state serum clozapine and N-desmethylclozapine concentrations (C/D) and insulin elevation during clozapine therapy were found to correlate with <i>CYP1A2</i> but not with <i>CYP2D6</i> polymorphisms. Furthermore, <i>HTR2C</i> and <i>HTR2A</i> polymorphisms were found to have significant influences on BMI and C-peptide levels in patients treated with olanzapine and clozapine. Evaluation of the impact of polymorphisms in genes encoding CYP3A4, CYP3A5 and P-glycoprotein (<i>ABCB1</i>) in addition to CYP2D6 on the steady state plasma levels of risperidone, 9-hydroxyrisperidone and their active moiety revealed a significant influence of <i>ABCB1 </i>genotype on 9-hydroxyrisperidone and active moiety C/Ds, while <i>CYP2D6</i> genotype associated with risperidone C/Ds but not with 9-hydroxyrisperidone or active moiety C/D. </p><p>We have shown that polymorphisms in genes involved in the pharmacokinetics and the pharmacodynamics of antipsychotic drugs play a role in the occurrence of adverse effects, both EPS and metabolic disturbances, induced by antipsychotic treatment. Genotyping for <i>HTR2A</i>, <i>HTR2C</i>, <i>CYP1A2</i>, <i>CYP2D6</i> and <i>ABCB1</i> polymorphisms may therefore potentially provide useful information to identify patients at higher risk to develop EPS or metabolic adverse during schizophrenia treatment with antipsychotic drugs.</p>

Genetically determined differences in drug metabolism and disposition and drug targets play a pivotal role in the interindividual variability in the clinical outcome of antipsychotic treatment. The aim of this thesis was to study the impact of polymorphisms in genes involved in the pharmacokinetics and pharmacodynamics of antipsychotics, with special focus on their extrapyramidal and metabolic adverse effects. Polymorphisms in serotonin 2A and 2C receptor coding genes (HTR2A and HTR2C) were found to be associated with the risk to develop extrapyramidal side effects (EPS) in patients on short term perphenazine treatment. A further study in a larger group of patients on long term treatment with various classical antipsychotics confirmed the association between occurrence of EPS and HTR2C polymorphisms. In another study, dose corrected steady state serum clozapine and N-desmethylclozapine concentrations (C/D) and insulin elevation during clozapine therapy were found to correlate with CYP1A2 but not with CYP2D6 polymorphisms. Furthermore, HTR2C and HTR2A polymorphisms were found to have significant influences on BMI and C-peptide levels in patients treated with olanzapine and clozapine. Evaluation of the impact of polymorphisms in genes encoding CYP3A4, CYP3A5 and P-glycoprotein (ABCB1) in addition to CYP2D6 on the steady state plasma levels of risperidone, 9-hydroxyrisperidone and their active moiety revealed a significant influence of ABCB1 genotype on 9-hydroxyrisperidone and active moiety C/Ds, while CYP2D6 genotype associated with risperidone C/Ds but not with 9-hydroxyrisperidone or active moiety C/D. We have shown that polymorphisms in genes involved in the pharmacokinetics and the pharmacodynamics of antipsychotic drugs play a role in the occurrence of adverse effects, both EPS and metabolic disturbances, induced by antipsychotic treatment. Genotyping for HTR2A, HTR2C, CYP1A2, CYP2D6 and ABCB1 polymorphisms may therefore potentially provide useful information to identify patients at higher risk to develop EPS or metabolic adverse during schizophrenia treatment with antipsychotic drugs.

Syftet med studien var att beskriva vilka biverkningar individer som behandlas med antipsykotika upplever och dess konsekvenser för livskvaliteten samt hur vårdpersonalen kan ge stöd till drabbade individer i vardagen för att minska obehaget av biverkningar. Metoden som användes var en avgränsad systematisk litteraturstudie. Vetenskapliga artiklar söktes via två databaser. Totalt inkluderades tio artiklar som genomgick kvalitets- och resultatanalys. Resultatet visade att vanligt förekommande biverkningar av antipsykotika som patienterna upplevde och rapporterade var psykiska, extrapyramidala följt av endokrina och metaboliska effekter samt övriga biverkningar som autonoma, antikolinerga och allergirelaterade. Resultaten visade att en sjuksköterskeledd vårdtjänst kunde upptäcka fysiska problem som ohälsosam livsstil och fetma och därmed åstadkomma positiv livsförändig och viktnedgång. Studierna ger även förslag på copingstrategier som stöd vid biverkningar trötthet och viktuppgång. Slutsatsen: Studien har visat att patienter med psykossjukdomar upplevde olika biverkningar av antipsykotika som de måste ta för att förebygga återfall i psykos. Det finns omvårdnadsåtgärder och stöd till patienter som gör det lättare att klara vardagslivet trots biverkningar. Dock behövs mer forskning om omvårdnadsåtgärder och stöd. / The aim of this study was to describe the side effects experienced by individuals treated with antipsychotics, their consequence in life quality and how care staff can give support to these individuals to reduce discomfort of the side effects in their daily life. The method was a determinate literature review. The scientific articles where found in the database PubMed. A total of ten articles where included and were analyzed based on their quality and contents. The results showed that the most common of antipsychotic side effects that the patient experienced and reported  were psychic, extrapyramidal followed by endocrine and the metabolic issue and other side effects with autonomic, anticholinergic and allergy related. The result showed that a nurse-led service with provided care delivery could discover physical health problems such as unhealthy lifestyle and obesity, and consequently achieve positive changes of life and weight loss. The studies even gave suggestions of strategies to cope with sedation, tiredness and weight gain. Conclusion of this literature review was that the patients with psychotic illnesses perceived different side effects from the antipsychotic medication that they had to take to prevent fallback in psychos. There is even nursing care and support to patients which make daily life easier in spite of side effects. However more research is needed about nursing methods and support.

Psychiatric disorders are believed to result from the combination of genetic predisposition and many environmental triggers. While the large number of disease-associated genetic variations have been recognized by previous genome-wide association studies (GWAS), the role of epigenetic mechanisms that mediate the effects of environmental factors on CNS gene activity in the etiology of most mental illnesses is still largely unclear. A growing body of evidence suggested that the abnormalities (changes in gene expression, formation of neural circuits, and behavior) involved in most psychiatric syndromes are preserved by epigenetic modifications identified in several specific brain regions. In this thesis, we developed the second generation of one of our microfluidic technologies (MOWChIP-seq) and used it to profile genome-wide histone modifications in three mental illness-related biological studies: the effect of psychedelics in mice, schizophrenia, and the effect of maternal immune activation in mice offspring. The second generation of MOWChIP-seq was designed to generate histone modification profiles from as few as 100 cells per assay with a throughput as high as eight assays in each run. Then, we applied the new MOWChIP-seq and SMART-seq2 to profile the histone modification H3K27ac and transcriptome, respectively, using NeuN+ neuronal nuclei from the mouse frontal cortex after a single dose of psychedelic administration. The epigenomic and transcriptomic changes induced by 2,5-Dimethoxy-4-iodoamphetamine (DOI), a subtype of psychedelics, in mouse neuronal nuclei at various time points suggest that the long-lasting effects of the psychedelic are more closely related to epigenomic alterations than the changes in transcriptomic patterns. Next, we comprehensively characterized epigenomic and transcriptomic features from the frontal cortex of 29 individuals with schizophrenia and 29 individually matched controls (gender and age). We found that schizophrenia subjects exhibited thousands of neuronal vs. glial epigenetic differences at regions that included several susceptibility genetic loci, such as NRXN1, RGS4 and GRIN3A. Finally, we investigated the epigenetic and transcriptomic alterations induced by the maternal immune activation (MIA) in mice offspring's frontal cortex. Pregnant mice were injected with influenza virus at GD 9.5 and the frontal cortex from mice pups (10 weeks old) were examined later. The results offered us some insights into the contribution of MIA to the etiology of some mental disorders, like schizophrenia and autism. / Doctor of Philosophy / While this field is still in its early stage, the epigenetic studies of mental disorders present promise to expand our understanding about how environmental stimulates, interacting with genetic factors, contribute to the etiology of various psychiatric syndromes, like major depression and schizophrenia. Previous clinical trials suggested that psychedelics may represent a promising long-lasting treatment for patients with depression and other psychiatric conditions. These research presented the therapeutic potential of psychedelic compounds for treating major depression and demonstrated the capability of psychedelics in increasing dendritic density and stimulating synapse formation. However, the molecular mechanism mediating the clinical effectiveness of psychedelics remain largely unexplored. Our study revealed that epigenomic-driven changes in synaptic plasticity sustain psychedelics' long-lasting antidepressant action. Another serious mental illness is schizophrenia, which could affect how an individual feels, thinks, and behaves. Like most other mental disorders, schizophrenia results from a combination of genetic and environmental causes. Epigenetic marks allow a dynamic impact of environmental factors, including antipsychotic medications, on the access to genes and regulatory elements. Despite this, no study so far has profiled cell-type-specific genome-wide histone modifications in postmortem brain samples from schizophrenia subjects or the effect of antipsychotic treatment on such epigenetic marks. Here we show the first comprehensive epigenomic characterization of the frontal cortex of 29 individuals with schizophrenia and 29 matched controls. The process of brain development is surprisingly sensitive to a lot of environmental insults. Epidemiological studies have recognized maternal immune activation as a risk factor that may change the normal developmental trajectory of the fetal brain and increase the odds of developing a range of psychiatric disorders, including schizophrenia and autism, in its lifetime. Given the prevalence of the coronavirus, uncovering the molecular mechanism underlie the phenotypic alterations has become more urgent than before, for both prevention and treatment.