Pharmacogenomics and Behavioral Health in the Treatment of Children and Teens

Kimberly Erlich, MSN, RN, MPH, CPNP, PMHS, Nurse Practitioner, Pacific Coast Psychiatric Associates & the Healthy Teen Project and Consulting Associate Faculty, Duke University School of Nursing, discusses pharmacogenomics and behavioral health in treatment of children and teens following her presentation on the subject at the 2020 Virtual Conference on Pediatric Health Care.

Alana Hippensteele: Hi, I'm Alana Hippensteele from Pharmacy Times. Before we get started, one of our top articles today discusses the dangerous cardiovascular complications of COVID-19. There’s more of that on PharmacyTimes.com.

Today, I’m speaking with Kimberly Erlich, Nurse Practitioner at Pacific Coast Psychiatric Associates and the Healthy Teen Project, as well as a consulting associate faculty at the Duke University School of Nursing, on pharmacogenomics and behavioral health following her presentation on the subject at the 2020 Virtual Conference on Pediatric Health Care.

So, Kimberly, what is your background in working with pharmacogenomics and behavior health?

Kimberly Erlich: So, I'm a pediatric nurse practitioner with a pediatric mental health specialty certification, so I'm double board certified in primary care and pediatric mental health. I've been working exclusively in pediatric and adolescent behavioral health over the last seven or so years, and currently working in two different outpatient settings. One is a more traditional outpatient psychiatric practice seeing, sort of, all-comers, all types of questions, problems, diagnoses across the spectrum of pediatric behavioral health, and then the other practice is exclusively focused on eating disorders in adolescents

Alana Hippensteele: Okay, great. Could you explain further what is pharmacogenomics?

Kimberly Erlich: Sure. So, pharmacogenomics is really the study of the impact of individual genetic variations on how the body processes or metabolizes certain medications and drugs.

Alana Hippensteele: Great. And could you explain how are pharmacokinetics and pharmacodynamics different?

Kimberly Erlich: Sure. So, pharmacokinetics refers to what the body does to the drug and pharmacokinetics therefore then includes different concepts such as absorption, distribution, metabolism, and excretion of these medications. In contrast, pharmacodynamics is referred to as what the drug itself does to the body—sort of the body's response to the drug.

Alana Hippensteele: Okay, great. And could you explain further what is genetic polymorphism?

Kimberly Erlich: Sure. So genetic polymorphisms are essentially just genetic variations among individuals.

Alana Hippensteele: Great, great. Why is it important to understand the options available for

pharmacogenomic testing?

Kimberly Erlich: So I think that it's important for both clinicians and patients to understand the options available for pharmacogenomic testing because it could impact their sort of trajectory of care and trajectory of disease in the long run. So specifically regarding how that relates to behavioral health, you know, we all know people who are adults who have struggled with different psychiatric symptoms for a number of years during their lifetimes, and I believe that we've all been sort of aware that that has caused a considerable amount of morbidity across their lifetime. Things like not being as successful as people as they'd like to, not being as successful in their careers and their personal relationships, possibly in their education. Some of these people that we can think of that we know in our lives have been through multiple medication trials, not quite finding just the right one, having lots of side effects that impact all of those other things that I mentioned in their lives, and that really takes a toll on them as individuals, their relationships, and sort of how they move through life. And if there's a possibility for pharmacogenomic testing to help decrease that morbidity that these people suffer really across their lifetime I think that's a wonderful opportunity.

Alana Hippensteele: Absolutely. Why is pharmacogenomic testing important when treating children and teens with behavioral disorders?

Kimberly Erlich: So that actually kind of piggy backs, right, onto the prior question. So I mentioned, you know, adults who've struggled with these symptoms across their lifetimes impacting lots of different areas, different domains, as we say, in their lives. One could argue, especially people who, like me, focus exclusively on children and adolescents, but that's even more important to kind of figure that out for clinicians to help families figure that out when people are younger, because we really do want to decrease the number of years that people struggle with symptoms, because we want to grow children and adolescents into successful adults, and part of how we do that is helping them to manage symptoms early on.

The other thing that I'd like to mention about that is it's well known that treatment for psychiatric disorders across kind of the spectrum of psychiatric disorders is known to actually work better when the brains are younger, when the brain is more dynamic. For example, it's well known from the substance abuse literature, for example, that the same treatment, either medication or therapy-based given at age 15 actually works better than it does started at age 25. If you were to wait till age 25 and not do any treatment at all and give that exact same treatment that a person who's 15 is getting but wait until they're 25, the treatment actually has the ability to work less well, and that's because the brain is more dynamic at a younger age. And so, I do think it's important to think about the tools in our toolbox to help move intervention forward and possibly change the trajectory of disease and remission of symptoms much earlier on.

Alana Hippensteele: Right, absolutely. Thank you so much for taking the time to speak with me today, Kimberly. Now let's hear from some of our other MJH Life Sciences brands on their latest headlines.