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Psychiatric Times. Vol. 28 No. 8
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NEWS 

Blood Tests for Diagnosis of Schizophrenia and Depression?

By Arline Kaplan | August 10, 2011

More recently, Bahn and her team used a multiplex molecular profiling approach to measure serum concentrations of 181 proteins and small molecules in 250 patients with first- and recent-onset schizophrenia along with 35 who had major depressive disorder (MDD), 32 who had euthymic bipolar disorder, and 45 who had Asperger syndrome. There were 280 control subjects. The results, published in Molecular Psychiatry, demonstrated that a biological signature of schizophrenia can be identified in blood serum, and this can distinguish persons with schizophrenia from healthy controls and from those affected by related psychiatric illnesses that have overlapping symptoms.3

VeriPsych’s launch

Since VeriPsych’s launch for schizophrenia in the fall of 2010, psychiatrists in a variety of treatment settings have ordered the test for hundreds of psychiatric patients, according to Michael Spain, MD, Myriad RBM’s Chief Medical Officer. The test costs $2500, and Spain said “numerous insurance carriers” are reimbursing for it. For patients without coverage, the company promises to work with them on “a reasonably acceptable financial assistance package.”

Spain said Myriad RBM is now “working on a differential product that would help to diagnose, identify, and discriminate schizophrenia patients from bipolar and unipolar patients.” It is based on the recent research conducted by Bahn’s team that was published in Molecular Psychiatry. Eventually, he added, the company hopes to expand the test’s availability to other countries.

“In the same way that a person with chronically high serum levels of glucose would be identified as diabetic and treated medically, tests like VeriPsych will hopefully allow for earlier diagnosis and treatment of major mental illness, which has been proven to lead to better patient outcomes,” said Spain. “Further, VeriPsych and our products in development help to underline the physiological and biological aspects of major mental illness and may hopefully lead to better understanding and treatment for patients with these disorders.”

Test for depression

In a scientific and clinical report session at the APA’s recent annual meeting, Perry Renshaw, MD, PhD, Professor of Psychiatry at the Uni-versity of Utah School of Medicine and Director of Magnetic Resonance for the Utah Brain Institute, presented clinical data on a multi-analyte blood test developed by Ridge Diagnostics, Inc, to aid in the diagnosis and management of MDD.

Founded in 2006, Ridge Diagnostics is located in San Diego and has its CLIA-certified laboratory in Research Triangle Park, NC, although it is planning for another lab in California. Its products are based on a proprietary Human Biomarker Library and Hyper-Mapping technology. In late 2010, the company began marketing its first-in-class blood test for MDD in Southern California and North Carolina. In the very near future, it plans to expand the test’s commercial availability throughout this country.

The diagnostic test was developed by researchers evaluating a variety of serum-based biomarkers implicated in key physiological processes involving depression. These include representative markers of the neurochemical, metabolic, inflammatory, and hypothalamic-pituitary-adrenal axis pathways, according to Ridge Diagnostic’s white paper.4

The current test measures 10 biomarkers: a1-antitrypsin, myeloperoxidase, soluble tumor necrosis factor receptor II, brain-derived neurotrophic factor, S100B, cortisol, epidermal growth factor, prolactin, resistin, and serum acylation-stimulating protein. The biomarker results are analyzed using a proprietary algorithm to provide a patient result, called an MDDScore. An MDDScore of 1 to 4 suggests a low probability of having depression; 5, a moderate probability; 6 to 9, a high probability.

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by Carla Thomas | September 22, 2011 4:53 PM EDT

The use of blood tests to diagnosed neurological disorders (i.e., psychiatric disorders) is long overdue. I agree that such tests will reduce the negative stigma associated with neurological conditions & the perception that those suffering with such disorders can simply change their behavior or receive conditioning techniques to free themselves from the disorder. The change in perception from the mind model to the neurological condition model will increase one's willingness to use medications to improve neurologic function. Now, if we can eliminate the negative stigma associated with terms such as, psychotic & psychiatric, so many people suffering with neurological conditions will become more open to seeking medical support to treat their symptoms. In the end, psychiatric conditions are neurological disorders because they stem from anomalies in genes/cells that impact brain function.

by Daniel Carlat | August 15, 2011 3:30 PM EDT

The depression blood test marketed by Ridge Diagnostics is something of a boondoggle. The two question PHQ-2 test is highly sensitive and specific for depression, and does not cost $745! See my post on this "biomarker" at http://carlatpsychiatry.blogspot.com/2011/08/blood-test-for-depression-really.html.

by Stephen Durrenberger | August 15, 2011 11:16 AM EDT

This is certainly a significant breakthrough for psychiatry, however, we must be careful not to draw too sweeping a conclusion from such research. While the blood test for Schizophrenia has great potential in helping identify patients earlier, I am deeply concerned that developing a blood test for MDD will lead to further short-cutting in the evaluation of patients by psychiatrists. It is prudent to note that the blood test CONFIRMED diagnoses that had previously been determined, but DID NOT CHANGE with medication treatment. This could mean that the individuals were biologically predetermined to develop depression, or, more likely, could indicate that medication alone is not adequate treatment for depression. Recent literature reminds us that the doctor patient relationship is far more important that once believed, when measuring response to treatment. The doctor needs to connect with the patient, adequately evaluate the patient, and pay attention to the social factors that lead to and fuel ongoing depression. We have abdicated the treatment of our patient population to primary care practitioners, alternative practitioners, and non-MD therapists for so long, we are losing touch with the essential roots of our profession. Evaluating and treating patients with depression should involve a detailed interview by the psychiatrist, not a 15 minute once-over and a blood test. Based upon the cost of the test, it is clearly more cost-effective to do the former, rather than the latter, so let us hope that the psychiatric community does not further abdicate its position, now to laboratory scientists!

by Robert Sands | August 12, 2011 11:01 AM EDT

This mechanistically diverse basket of markers with relevant physiologic underpinnings is quite interesting, especially if it has "85% specificity and sensitivity". I have watched many markers come and go with varying degrees of value. I always come back to the clinical reality, which is the basis for judging the markers value in the end. Brain imaging "markers"(patters of blood flow or activity)have teaching value but are generally of little value in the individual case

The "marker" approach will have more use in genetic counseling and working with family members of mentally ill than with those individuals with established mental illness who could care less about their markers, since they already have the full expression clinically. If the markers (basket of markers) could predict penetrance of illness (which is quite variable) that would be a big deal. It would help define the Cannabis/pychosis risk group.
Robert E. Sands, MD






 
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