An Orchid Series
a wide-ranging potpourri to make reform easy
1. Science Up
This is pretty controversial advice in the mental health community, given the long sorry history of people with "mental illness" used unsuccessfully as guinea pigs for the newest, latest greatest idea.
(See Mental Health Advocate Amy Smith's Rebuttal to some of our previous "science-based" arguments)
Having said that the mental health profession is currently clinging to some pretty demonstrably out-moded ideas such as those contained in the DSM-5 which most mental health advocates aren't happy about either.
(Dr. Tom Insel, then head of the National Institute of Mental Health states the DSM-5 "lacks validity" :
"The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.
"In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever.
"Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.
"Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system."
Further, some members of the mental health profession are waltzing into court and testifying to all kinds of things they couldn't possibly know.
We really do need to get the mental health profession on a sounder scientific footing that is being done on a variety of fronts including the National Institute of Mental Health's RDoC Program.
"This approach (RDoC) began with several assumptions:
"It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data.
"In this sense, RDoC is a framework for collecting the data needed for a new nosology. But it is critical to realize that we cannot succeed if we use DSM categories as the “gold standard.”
"The diagnostic system has to be based on the emerging research data, not on the current symptom-based categories.
"Imagine deciding that EKGs were not useful because many patients with chest pain did not have EKG changes. That is what we have been doing for decades when we reject a biomarker because it does not detect a DSM category.
"We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response.
"That is why NIMH will be re-orienting its research away from DSM categories. "
Below are some of our thoughts on pharmacogenetic testing and making reform "easy."
There are a whole lot of people, a whole lot of mental health professionals, a whole lot of county attorneys, and a lot of judges that generally think everything would be just great if that recalcitrant person with a "mental illness" would just take the psychiatric medication like he or she was supposed to.
Of course, according to the New York Times we have 1 in 6 adults in the US saying they have taken psychiatric medication.
Further, at least sometimes, there are significant "reasons" why people may be resisting certain medications beyond mere delusion.
We really are having to come to terms with the incredible need for individualized medicine, and certainly individualized psychiatric medicine.
Using the buying power of the VA (which is being done) and Medicaid, we could really:
GeneSight has a contract with the US Dept. of Veterans' Affairs to provide pharmacogenomic testing to help guide clinicians’ medication decisions for veterans being treated for behavioral health conditions. https://genesight.com/va/
List of Medications for which GeneSight provides pharmacogenomic testing:
Mental disorders are among the most complex problems in medicine, with challenges at every level from neurons to neighborhoods.