PRACTICAL GENETICS
IS PERSONALIZED MEDICINE POSSIBLE IN MENTAL HEALTH CARE TODAY ?
AUTHOR John Wernert , MD , MHA
Our active practitioners know this scenario . You are running 30 minutes late on a busy clinic afternoon , and one of your well-known patients is next up for an annual physical . After a quick hello , this knowledgeable patient reveals that she has been struggling over the past year with severe mood swings , poor sleep and obsessive worries . Her mother was diagnosed with bipolar disorder , and your patient wonders if she is also bipolar . She reveals that her domestic partner is really worried and told her , “ You need to get on some medication !” She hands you the results of a genomics test she bought on Amazon and asks which medicine would be best for her . You think to yourself , “… My last genetics class was 1984 in medical school .” Your MA knocks on the door to tell you your next patient is ready .
These scenarios will become more frequent as the field of personalized medicine becomes the standard in health care in America . In other industrialized countries , the adoption of personalized medicine , often referred to as precision medicine , has already become the standard of care . In the US , we use genetic testing in specialized fields , such as pediatrics developmental screening or oncology . But with the wide availability of new genomics testing , often marketed directly to consumers , the popularity of personalized genetics tests is now a reality for even our primary care practitioners .
As defined by various scientific groups , personalized medicine is an evolving field in which physicians use molecular diagnostic tests to determine which medical treatments and strategies will work best for their patients . By combining the data from those tests with an individual ’ s medical history , circumstances and values , health care providers and patients can develop targeted treatment and prevention plans . However , there are fundamental gaps in awareness and access that impact the speed at which personalized medicine treatments and strategies are integrated into health care . In our systems focused on better outcomes and efficient service delivery , is there a place for such genomics testing ?
Mental health and psychiatric treatments are already complicated by overcoming stigma , shifting attitudes , refined diagnostic criteria and ever-evolving medication choices . So can a primary care provider truly rely on a genetic test to inform the decision about
( continued on page 14 ) APRIL 2021 13