Treating a patient with a mental health issue is unique within the medical field. They are often dealing with paranoia, anxiety, social withdrawal, depression, or a combination of these symptoms and others.
In addition, society has generally been slow to acknowledge and accept mental illness. There is a still a feeling that a patient may be “faking it” or just needs to “get over it,” so it’s important that we help our patients understand their mental health treatment options.
Right now, there is no genetic test that can determine if a patient has a mental illness or if he or she is likely to develop one, as exists with breast cancer.
However, there are advancements in the field that the public is starting to embrace. Most Americans (67%) say they would be willing to take a genetic test to determine the best treatment plan for mental illness if they received that recommendation from a clinician. That’s an increase of 4% for that question over last year, according to the 2017 Genomind Mental Health Poll.
While the people polled were more open to taking a genetic test if diagnosed with cancer (76%), heart disease (75%), or diabetes (72%), the disparity between the acceptance of genetic testing for mental health treatment and for the treatment of those other chronic illnesses is shrinking.
As a psychiatric and addictions advanced practice nurse, I think there are reasons for this change. First, more Americans in the poll said they knew an immediate family member, relative, or friend diagnosed with mental illness (31% stated this, which is up 3% in the past year). There were large increases the answer to this question among Hispanics (a 9% increase) and those in the South (an 8% increase), compared to the 2016 results. When we know someone dealing with a mental health struggle, I think we are more willing to understand and accept expanded mental health treatment options.
I believe there is also an increased understanding that prior to genetic testing, all we had with pharmacotherapy as clinicians was an often lengthy trial-and-error process based on the symptoms presented, the clinician’s education and experience, and the drug’s indications.
Monitoring for Polypharmacy
Clinicians and patients are also increasingly concerned about polypharmacy, the concurrent taking of multiple medications, which is especially prevalent in the elderly. The use of genetic test results to better understand polypharmacy could be another way to build support for such testing.
For example, I treated a 74-year-old woman who initially presented with 26 different medications (over-the-counter, supplemental, and prescription) that she was taking on a daily basis.
Because the patient’s symptoms were not well controlled, the information offered through the genetic test results and an online drug interaction tool were especially helpful in suggesting which drugs may have been contributing to adverse effects, which drugs may have been less effective based on her genetic variants, and which drug–drug interactions may lead to potentially harmful events. The tool that I use, the Genomind Drug Interaction Guide (G-DIG), also allows clinicians to assess how smoking or drinking coffee can affect the patient’s specific drug metabolism.
Utilizing the results from the patient’s genetic test and the information from G-DIG, I was able to explain to the patient the drug–drug interactions that might be interfering with her overall well-being.
Additionally, I was able to determine which of the various drugs she was currently taking would likely not have the intended effect or, worse, lead to some of the side effects she was experiencing based on her unique genetic variants. The patient and her family were eager to begin chipping away at the medications which testing had indicated had a potential lack of efficacy or an increased risk of adverse events.
As the patient’s medication profile was extensive, we began slowly, so her medical condition would not become destabilized. Over a period of a few months, we were able to eliminate 10 drugs from her regimen. The patient began to experience greater energy, less pain, increased motivation, and overall a better self-reported quality of life.
An important point to emphasize is that the genetic test is neither directive nor diagnostic. For those prescribing advanced practice nurses and other clinicians who may feel challenged by interpreting the results of genetic testing, I can assure you it is well within your ability to do so and that the companies that offer the testing have extensive clinical support teams to guide you through the results and the pharmacological decision-making process if the need arises. I will also point out that genetic testing to personalize medication decisions is not a new science: Oncology clinicians have been utilizing such reports for years to personalize chemotherapy regimens for their patients.
With the ability to test for drug metabolism, drug–drug interactions, and the possibility of how or if a drug will work for a patient, more individuals are now willing to explore genetic testing to clarify and personalize mental health treatment for psychiatric disorders. In my experience, the ultimate result has been healthier and happier patients.
- Helping Patients Understand Mental Health Treatment Options - November 9, 2017
- The Value of Genetic Testing to Psychiatric Nursing - July 20, 2017