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By Robert Cuyler, Ph.D.

Here’s a great analogy from the 2014 OPEN MINDS Technology & Informatics Institute:

A patient walks into the emergency room with racing pulse and chest pain, fearing a heart attack. The ER physician will think of multiple causes for the patient’s chest pain (e.g. heartburn or panic attack), but will still order an EKG and cardiac enzymes instead of guessing based on the patient’s symptoms. It’s a fairly simple and scientific model to reach a diagnosis and treatment plan in emergency medicine. But those same tools have not been available to mental health professionals, who are forced to rely solely on the patient’s description of symptoms.

nancy_grden2This was the analogy presented by Anne Marie Dietrich, M.D., a psychiatrist, in the session Behavioral Health Moves Toward Personalized Medicine: How Genetics Are Changing Treatment for Provider Organizations and Consumers, that included panelists Nancy Grden, General Manager, GenoMind, Inc.; Tim Ramsey, Vice President of New Product Development, Suregene, LLC; and Julie Wood, M.D., Staff Psychiatrist, Southwestern Behavioral Health.

tim_ramsey2While definitive psychiatric diagnostics may still be years away, genomics and personalized medicine are starting to transform the “trial and error approach” to mental health treatment by optimizing medication choice for individual patients. What does this mean for the field? From the standpoint of technological development, Nancy Grden and Tim Ramsey provided a look at those latest developments.

Ms. Grden updated the attendees on the work of Genomind (see Genomind Secures Series A Investment Led By Claritas Capital To Fund Growth Of Their Personalized Medicine Company), which provides a saliva-based test that clinical professionals can use to identify the genetic markers that can help predict patient responses to psychiatric treatments. Her advice on the day? If you are looking to provide tailored treatment and reduce the “trial-and-error” that currently adds to higher health care costs (and the cost of mental health isn’t going away), investigating the possibilities of personalized medicine is an important strategic step. Mr. Ramsey of SureGene (see SureGene & PGXL Laboratories Launch Test For Antipsychotic & Antidepressant Response and SULT4A1-1 Guided Antipsychotic Therapy Can Greatly Reduce Schizophrenia Hospitalization Costs), a company that has developed a test to assess likely patient response to antipsychotic and antidepressant medications, offered a very clear-cut management goal. Personalized medicine should allow a clinical professional to work with consumers to make treatment decisions rapidly and accurately.

What does adoption look like in the field? Dr. Anne Marie Dietrich is a psychiatrist in practice for 20 years who has used the Genomind testing with 150+ consumers and Dr. Julie Wood, a psychiatrist at Southwestern Behavioral Health, has used the Surgene testing with 65+ consumers. Their take on the benefits of adopting this kind of personalized medicine? Dr. Dietrich has seen greater medication compliance and a greater ability to explain why some consumers are struggling with side effects and inadequate response to treatment.  Dr. Wood reiterated the improved rapport between herself and consumers and noted that as a conservative professional who believes in minimum necessary dosage and avoidance of poly-pharmacy, these test greatly improve a consumer’s risk-to-benefit profile.

My takeaway on the day?  Consumers and professionals see the benefits of genetic testing to “personalize” treatment plans (see Behavioral Health Moves Toward Personalized MedicinePersonalized Medicine Hits A Bump In The Road and Where Are We With Personalized Medicine: What’s Available Now & What Is On The Horizon?), but we have not yet arrived at widespread payer adoption (see Genetic Testing For Mental Health Conditions). Perhaps last month’s decision by CMS to cover a genomic test – Medicare To Cover Assurex Health Genetic Test GeneSight Psychotropic To Guide Antidepressant Treatment – is an indication that the payer view is changing?

For more, check out the new developments in the market – Local Coverage Determination (LCD) MoPath: Genetic Assay for Refractory Depression (DL35443) Released by CGS Medicare and Blood Test For Major Depression Developed; Can Predict Efficacy Of Treatment Using CBT. And, check out our post-institute coverage of The 2014 OPEN MINDS Technology & Informatics Institute; or our archived coverage on Twitter @openmindscircle #TII14, and on Facebook at www.facebook.com/openmindscircle.

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