Blood Testing For Mental Illness...

[xbittergracex]

Blood test could reveal bipolar disorder

Method that could diagnose, assess patients also raises ethical question

By Steve Mitchell

MSNBC contributor

updated 5:01 p.m. ET, Mon., Feb. 25, 2008

A blood test could be used to diagnose and assess the severity of certain mental illnesses, such as bipolar disorder, according to a new study. But some experts think this raises ethical concerns about prying into a person's mental status.

Lab tests that can accurately detect mental illnesses have long been considered the “Holy Grail” of psychiatry. Currently, bipolar disorder and other conditions such as depression are diagnosed based on the patient's description of their symptoms and the physician's judgment, sometimes making it difficult to get an accurate diagnosis or determine the severity of a patient's condition. But now researchers have shown that 10 genes that can be detected in the blood could provide a better way to assess a patient.

“Patients aren’t sure how ill they really are, and neither is the clinician — sometimes dismissing their symptoms, sometimes overestimating them,” said Dr. Alexander Niculescu, III, a psychiatrist at the Indiana University School of Medicine in Indianapolis, who led the research published Tuesday by the journal Molecular Psychiatry. “Having an objective test for disease state, disease severity, and especially to measure response to treatment, would be a big step forward.”

More work remains to be done to confirm these findings, Niculescu said, adding that tests could hit the market in as little as five years.

The goal of the new study was to identify genes or biomarkers that could be used to track the severity of the symptoms of mania or depression in people already diagnosed with bipolar disorder, but these same genes could ultimately be turned into a test to make an initial diagnosis, he said.

Niculescu, who is also working on identifying biomarkers for diagnosing anxiety and stress as well as hallucinations in schizophrenia, said the bipolar findings could be the dawning of a new age in psychiatry. “It would put psychiatry on par with other medical specialties,” he said.

This could be especially helpful for ensuring a patient is getting the right medication. Bipolar patients are sometimes first seen by a physician during one of their low periods. Consequently, they may be misdiagnosed with depression and prescribed antidepressants, which can trigger a dangerous manic state. A blood test that could be used to monitor the patient might enable physicians to catch this mood elevation before it was too late.

“This may be especially important in children and adolescents, who are hard to diagnose for sure using clinical criteria only, and in whom mood states can change fast, sometimes dangerously so,” Niculescu said.

Beyond the stigma

Dr. Carlos Pato, chair of the psychiatry department at the University of Southern California School of Medicine in Los Angeles, thinks a test for mental illness should be viewed no differently than a test for other medical conditions, such as diabetes or heart disease risk.

“We should look beyond the stigma of a mental illness because the most important thing is to have a very clear diagnosis to get the best treatment for the patient,” Pato said.

Genetic testing for disease has long been controversial, but Art Caplan, director of the Center for Bioethics at the University of Pennsylvania and an msnbc.com columnist, said a genetic test for mental state could intensify that debate.

“We're likely to see much more controversy with genetic testing when it's about behavior, mental states and personality characteristics than when you're testing for cancer risk or prostate problems,” Caplan said.

The tests are particularly concerning if they could be used to screen for mental illness in the workplace or for college admittance, Caplan said. Other controversial areas include requiring people pass a blood test for mental competency to purchase a gun or for high sensitivity jobs, such as police officer or to enroll in the military.

Genes predict mood state

In the new study, designed to assess the severity of the disease, Niculescu's team first drew blood samples from 29 bipolar patients (27 men and two women) who were also asked about their mood level at the time of collection.

The researchers looked for differences in gene activity (whether the genes were turned on or off) between the high and low mood groups. They then incorporated the results with genetic data from animal models and gene activity from samples taken from the brains of deceased bipolar or depressed patients. The comparison enabled them to identify 10 genes for predicting mood state. (It is not yet known if any of these genes play a direct role in causing bipolar disorder or depression.)

By calculating a score based on whether each gene is active in a blood sample, the researchers could predict high mood if the score was high and low mood if the score was low. When these genes were examined in the initial group of patients, the calculated scores were 85 percent accurate in predicting high mood and 77 percent accurate in predicting low mood.

While this isn't perfect, Niculescu said this accuracy rate is within range of other medical tests, such as some cancer screening methods.

But one challenge of the test could be a disconnect between the results and how a patient says they feel, said Dr. Peter Rabins, a psychiatrist at Johns Hopkins University's Berman Bioethics Institute in Baltimore. Rabins noted that in cases of severe depression, a patient sometimes will look better to their friends and doctors after starting treatment, but will say they don’t feel better.

“So who's right? The patient or the test?” he said. “Ultimately, my feeling would be we have to listen to the person and what they're experiencing and not the blood test.”

Steve Mitchell is a science and medicine writer in Washington, D.C. His articles have appeared in a variety of newspapers, magazines and Web sites, including UPI, Reuters Health, The Scientist and WebMD.

© 2008 MSNBC Interactive

[punk_princess]

I went to a seminar a few days ago about Tourettes Syndrome. They mentioned that by taking the dna from blood they can find out if you have the genetic markers for the disorder. I'm considering having my daughter tested since I have Tourettes.

[Onyx]

Very interesting. That would seem to point to a physical cause for some mental difficulties.

[xbittergracex]

I'm very torn on this subject because...of course medically I think its fantastic and a huge breakthrough. Especially since medications that treat mental disorders are handed out like candy anymore, and like the article says...this can have horrible effects to certain types of disorders, causing MORE emotional damage and more suicides..etc...

HOWEVER....

I can see this being an invasion of privacy in other areas. Such as employment. Most places you take a piss-test for a drug screening....imagine they start paying to have blood testing done, and start looking at more than drug content.

Would things like this come into play when it comes to blood donations and things like that?

I think that since the medical community is extremely controlled by the government...the conspiracy theorist in my head starts to wonder that if our blood can give evidence of our mental health as well....this could eventually cause serious problems when it comes to the privacy of health issues.

Not being paranoid or anything....again...I think its a generally good thing....but I think its a little scary that doctors/scientists can look through a microscope and sort of see into your mind a little....

[Kit Kat P]

My other worry is a blood test that rule you out for insurance based on a pre-existing condition.

[Msterbeau]

Clearly, this would require some sort of legislation as to what can and cannot be done with the information as well as what sorts of testing people are allowed to do.

[jadnifer]

As for someone who is bi-polar, I think that it is good if they ONLY use it to determine whether you have the disease or not and the severity of it.

If used for anything else, IMO, is unethical.

[freydis]

I'm very torn on this subject because...of course medically I think its fantastic and a huge breakthrough. Especially since medications that treat mental disorders are handed out like candy anymore, and like the article says...this can have horrible effects to certain types of disorders, causing MORE emotional damage and more suicides..etc...

HOWEVER....

I can see this being an invasion of privacy in other areas. Such as employment. Most places you take a piss-test for a drug screening....imagine they start paying to have blood testing done, and start looking at more than drug content.

Would things like this come into play when it comes to blood donations and things like that?

I think that since the medical community is extremely controlled by the government...the conspiracy theorist in my head starts to wonder that if our blood can give evidence of our mental health as well....this could eventually cause serious problems when it comes to the privacy of health issues.

Not being paranoid or anything....again...I think its a generally good thing....but I think its a little scary that doctors/scientists can look through a microscope and sort of see into your mind a little....

Gattaca, anyone?

[Rev.Reverence]

A Brave... New... World...

*viably shivers*

[Kit Kat P]

On a side note I'm hoping they do make more progress in this matter for people like my little sister. She's so 'different' after all the drugs but I knew before the drugs that she has somethings that she needs help w/ and know that she is altered w/ a blood test they would be far more likely to help instead of just saying "it's the drugs".