High-tech Diagnosis Yields Clues Into Mental Illness?
Is there a definitive test for mental illness? Not yet, but using advanced neuropsychiatric diagnostic tools including magnetic resonance imaging (MRI) and positron emission tomography (PET), mental health professionals at The Menninger Clinic in Houston claim to be pinpointing the causes of behavioral and psychiatric problems in patients. Alas, this approach is begging the question. First it remains to be seen, if there exists any structural cause for “behavioral and psychiatric problems” at all. Next, there seems to be a need to go back to read some Foucault, as Madness and Civilization (A full translation titled The History of Madness has been published by Routledge : ISBN 0-415-27701-9), thus finding out how such problems can be caught in a definitional frame without getting stuck in normative thinking. Otherwise appropriateness of interpretation is always going to taint the precision of data , be it from MRI, PET, or both together.
“Even though a patient may have a straightforward mental health diagnosis or diagnoses, the neuropsychiatric approach can help us rule out medical or neurological reasons for the patient’s symptoms before we settle on a psychiatric reason,” says Florence Kim, M.D., director of the Menninger Comprehensive Psychiatric Assessment Service.
Launched in April, the Assessment Service provides adults who have behavioral and psychiatric issues with a thorough two-week assessment, including extensive neuropsychiatric testing. The service is designed as one stop for thorough assessment for individuals who are not making adequate progress in other treatment settings, desire a second opinion, require a thorough psychiatric assessment to determine what treatment program may fit their needs or who were referred by their clinician.
Patients in the program also undergo a psychiatric evaluation, extensive neuropsychological testing, psychological testing, psychosocial evaluation, a family system study and a neurological consult. Menninger’s affiliation with Baylor College of Medicine provides patients with access to consultants in neuropsychology and neurology for help with brain disorders such as stroke, Alzheimer’s disease, multiple sclerosis and traumatic brain injury.
The Assessment Service also offers genotyping for patients who don’t respond well to psychiatric medications. A simple blood test can reveal whether a patient may metabolize a drug too fast, which provides the patient with little benefit, or metabolizes the drug too slowly, which can increase the amount of drug that builds up in the body, causing side effects such as nausea. Currently, doctors prescribe psychiatric medications based on their experience of what works best, but they can’t predict how medications will work in each individual patient. As a result, patients may spend several months or years trying to find the best medication with the fewest side effects.
The battery of tests used in the assessment yields a wealth of information, providing unique insight into the patient’s mental and behavioral health, in addition to the patient’s personal history. In some cases, the information may reveal an underlying medical condition, such as dementia or damage caused by a brain injury. It may also help better diagnose the type and the severity of mental illness or behavioral disorder the patient may have. The evaluation looks at all facets of a patient’s life and clinical picture before making treatment recommendations.
“One of our recent patients, an 18-year-old, came into the program as result of an intervention,” Dr. Kim says. “He had been labeled with a diagnosis, but as a result of our examinations, we were able to clarify that diagnosis. He told us, ‘finally, someone understands what’s going on.’”
As a result of his assessment, the patient changed his plans and immediately sought treatment.
At the end of a two- to three- week evaluation, the assessment team provides patients with findings and recommendations for their next steps. About half of patients choose to remain at Menninger for their treatment. Patients may also use the assessment to help guide their treatment at other psychiatric facilities, or outpatient treatment.
Dr. Kim sees the Assessment Service as an increasingly valuable tool to diagnosis and treat patients with psychiatric disorders.
“We are at the beginning of a new age in terms of what we can do for people with psychiatric illnesses,” she says. “In the next 20 to 30 years, we are going to see an explosion in brain research, and we’ll understand so much more about the genetic basis for many conditions. It’s a very exciting time.”