Usually at congresses, delegates are furtive about getting out their smart-phones during the lectures. Not so in a session called “How the Neuroscience-based Nomenclature (NbN) can change my practice.” Our correspondent explains why.
Inappropriate and outdated class names for various types of medication are hampering the way that psychiatrists think about and choose treatments, and may even be detrimental to patient acceptance and compliance with effective therapies.
Recognizing this state of affairs, an international task force has worked tirelessly in recent years to come up with a new method for classing and describing pharmacotherapies indicated for the management of mental disorders. The Neuroscience-based Nomenclature (NbN) system was launched last year and as its name suggests – this nomenclature is based on the pharmacology and mechanism of action of a drug entity.
Chairing a session in which the NbN App was showcased, Professor Joseph Zohar of Israel, outlined the rationale for revising the way in which agents used in which medications used in the treatment of mental disorders are described. He said that while the classification given to drug treatments at the time of their discovery and approval for clinical use may have seemed apposite at the time, almost invariably, these “labels” have proven rigid and incomplete. He gave examples of certain ‘antipsychotic’ agents which are indicated and used for the management of depression.
Poor connotation
As Professor Zohar explained, this disconnect between the name and the condition can be troubling for patients. He said patients prescribed an ‘antipsychotic’ therapy for depression might perceive this to mean their condition is ‘so bad’ that it needs a different type of drug. For patients, the old classification system was therefore fraught with false implications that could impact on patient adherence.
Professor Zohar and his faculty, Professors Hans-Jürgen Möller of Germany and Professor Stephen Stahl from the USA, also reminded delegates that to some extent the old nomenclature limited the way in which clinicians viewed and selected medications. They also said that labels such as ‘second generation’ and ‘atypical’ as applied to antipsychotics to reflect historical timings of drug introduction, rather than really providing a profile or identifier of the activity of a therapeutic agent.
The NbN takes a grass-roots approach and classes and labels an agent according to its predominant pharmacology. Where a medicine has a very complex pharmacology, as for example is the case for some of the newer antidepressant agents which are not only SSRIs but have agonist and antagonist activity at a number of other receptors, a label of ‘multimodal’ is used to better describe the mode of action.
All becomes clear in the App
Demonstrating the NbN App, the faculty showed how this includes information on five key dimensions of a treatment – its NbN class, the approved indications, efficacy & safety, practical notes (on clinical data), and neurobiology (preclinical/empirical data).
The App allows users to search using these five dimensions and is flexible and easy to use. There are plans to ensure that the App, which currently has entries for 108 drug treatments, is updated at least twice a year.
Delegates were shown the NbN 3d barcode on screen – and there was a profusion of ‘phone clicking and snapping in the room as the audience downloaded the free App and tried it out during the session.
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
