DRD2/ANKK1 Taq1A (rs 1800497 C>T) genotypes are associated with susceptibility to second generation antipsychotic-induced akathisia.

Although the advent of atypical, second-generation antipsychotics (SGAs) has resulted in reduced likelihood of akathisia, this adverse effect remains a problem. It is known that extrapyramidal adverse effects are associated with increased drug occupancy of the dopamine 2 receptors (DRD2). The A1 allele of the DRD2/ANKK1, rs1800497, is associated with decreased striatal DRD2 density. The aim of this study was to identify whether the A1(T) allele of DRD2/ANKK1 was associated with akathisia (as measured by Barnes Akathisia Rating Scale) in a clinical sample of 234 patients who were treated with antipsychotic drugs. Definite akathisia (a score ≥ 2 in the global clinical assessment of akathisia) was significantly less common in subjects who were prescribed SGAs (16.8%) than those prescribed FGAs (47.6%), p < 0.0001. Overall, 24.1% of A1+ patients (A1A2/A1A1) who were treated with SGAs had akathisia, compared to 10.8% of A1- (thus, A2A2) patients. A1+ patients who were administered SGAs also had higher global clinical assessment of akathisia scores than the A1- subjects (p = 0.01). SGAs maintained their advantage over FGAs regarding akathisia, even in A1+ patients who were treated with SGAs. These results strongly suggested that A1+ variants of the DRD2/ANKK1 Taq1A allele do confer an associated risk for akathisia in patients who were treated with SGAs, and these variants may explain inconsistencies found across prior studies, when comparing FGAs and SGAs.

A GP prescribing educational intervention involving a medication panel.

AIM: To trial an educational intervention for general practitioners promoting Quality Use of Medicines. METHOD: Twenty-three general practitioners (GPs) from the Brisbane Inner South Division participated in 12 prescribing upskilling sessions over 13 months. The educational intervention utilised an interactive small group, case based approach with panel input from a GP, pharmacist, clinical specialist, consumer with a related diagnosis, and clinical pharmacologist, focusing on areas of nominated interest. Participants also had access to a therapeutic drug management phone service. RESULTS: Twenty-one (91%) participants completed nine or more sessions and a total of 319 of a possible 324 (98.5%) format evaluations were completed on educational sessions three to eleven. Pre and post session multiple choice questions (MCQs) were used to evaluate change in prescribing knowledge for eight of the sessions. All sessions showed a statistically significant improvement post intervention in both individual participant and overall group knowledge scores (p < 0.001). Participant feedback highlighted that: 100% agreed or strongly agreed that the educational content, panel discussion and summaries were relevant to their practice; 80% agreed or strongly agreed that the sessions were helpful in the management of their patients; 85% agreed or strongly agreed that they had gained new knowledge/skills they would apply in their practice. The therapeutic drug management phone service was utilised at least once by 72% of participants. DISCUSSION: The use of an interactive, case based prescribing intervention with medication team input, positively influences GP prescribing knowledge and management intent.