New Directions in Psychopharmacology Jarrett Barnhill MD Moderator Takahiro Soda MD, PhD TC Bethea MD Jim Bedford MD

Introduction One of basic problems in psychopharmacology in general is high rates of improvement, modest at best rates of remission, disturbing rates of nonresponse, and in some cases high rates of placebo response Heterogeneity of psychiatric syndromes, ID and ASD- dueling heterogeneities; incomplete understanding of drug effects Most psychiatric disorders are neurodevelopmental in nature, expressed behaviorally, and are the end results of complex intertwining transactions with ID and ASD (entanglement)

Syndromal Heterogeneity, psychotropic medications and RDoC Specifiers- subsyndromal forms of primary disorders, prodromal symptoms (attenuated, developmental trajectory) Age of onset, comorbidity, and traditional biopsychosocial models Polygenic inheritance, complex patterns of gene X environmental interactions; critical threshold and heritability Early disruptions in the developmental trajectory (perinatal and postnatal insults) Combination of gene/neurophysiological biomarker/neurobiological markers, Temperament and patterns of attachment behaviors. What do we do with the ID domains- areas of conceptual, social and practical skills, skill deficits and behavrioal excess associated with many psychiatric disorders (baseline exaggeration)

Dramatis personae Soda- genomics and gene studies Bedford- psychopharmacological interface with autisms Bethea- general overview of where we are and hopefully going Please save questions until the discussion period.