tag:blogger.com,1999:blog-7772182113499451603.post7273039805002307626..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: Depression and the Genetics Of Large CombinationsGeorge Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-7772182113499451603.post-36873594059020422632015-07-25T11:33:57.133-05:002015-07-25T11:33:57.133-05:00Well none of these psychometrics are perfect and m...Well none of these psychometrics are perfect and many flaws that people point out are legit but that can be said of any psych medication even more so. A lot of people like to beat up on IQ tests but it's pretty impossible to score 130 on one unless you are pretty bright. And if an MMPI-2 in a depressed person shows elevated 6 and 8 scales, it may not mean they are psychotic, but going over the critical items with the patient is a good starting point for further assessment. If nothing else, the PAI and MMPI give the clinician a chance to ask many questions that there simply isn't time for in an interview.<br /><br />Because of some of these on line conversations I have had with psychologists, they have convinced me of the utility of the PAI. I took a dry run myself on one and I was pretty sold on it. <br /><br />I prefer to think of these are marking "clinical features" rather than diagnosis. And I seriously doubt that mental health biological markers such as SNP combinations will ever be useful for more than "clinical features". There will never be a genetic marker for PTSD (although maybe for those more likely to develop symptoms under extreme stress which will be actuarial, like MTHFR).James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-30481165235509379542015-07-25T00:34:50.714-05:002015-07-25T00:34:50.714-05:00"I'm a little confused. You're saying..."I'm a little confused. You're saying that the MMPI misdiagnosed people yet you're saying it was not designed to make diagnoses. That's not a rap on the MMPI since they made that disclaimer, that's a rap on misuse of the MMPI."<br /><br />Well maybe....<br /><br />But I can tell you that here in the home of the MMPI, most of the results almost always contain a diagnosis or sorts. As you know there is a famous Minnesota psychologist who refers to the "actuarial" aspects of the MMPI and how it is better than a clinicians diagnosis. We used to ask these guys why they don't leave it at the "actuarial" level and why even the computerized interpretations include DSM diagnoses. My guess is that they need a diagnosis for billing codes and the people buying the programs want their money's worth.<br /><br />I testified in an NGRI hearing once and and expert for the other side was trying to explain why the patient was not psychotic. He conveniently did not mention an elevated Goldberg Index. When I researched it at the time, one of the top texts in the area suggested that if the index was used that cutoffs should be "empirically determined" by the clinician for each population it is used in. That suggests to me that whether you call it a diagnosis or not, the test is used to determine "psychosis or no psychosis" for some reason and at some level it is validated by what clinicians think.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-46189140138848474282015-07-24T19:18:41.371-05:002015-07-24T19:18:41.371-05:00This is the year I made the transition from MMPI-2...This is the year I made the transition from MMPI-2 to PAI, and it was largely out of concern on some of the dated questions. Liking mechanics magazines and reading daily newspapers is probably something no one under 40 does on a regular basis. Even while MMPI was not a diagnostic tool, it did tell you what your profile had in common with those of pure pathology and unlike the PHQ-9 it asks dozens of questions about depression and other symptoms that you simply don't have time for. It's also incredibly useful in forensics in separating the wheat from the chaff.<br /><br />Genetic markers are mostly actuarial (unless its something like Huntington's). You might have a marker that would make you more vulnerable to venous thrombosis (23andme used to be able to show you this) but that doesn't mean you will get one. In other words, it's really not going to be that much better than a good family history.<br /><br />I'm a little confused. You're saying that the MMPI misdiagnosed people yet you're saying it was not designed to make diagnoses. That's not a rap on the MMPI since they made that disclaimer, that's a rap on misuse of the MMPI.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-80116136531571758172015-07-24T17:14:55.392-05:002015-07-24T17:14:55.392-05:00"Hey I know some at NIMH want psychiatry to b..."Hey I know some at NIMH want psychiatry to be as empirical as ophthalmology, but I don't see how that works in the real world. I really think they haven't thought it through"<br /><br />I think it will happen but the measurement will be a lot different. The relevant patterns of illness are not as obvious as looking at various eye diseases, but the markers will eventually be there. Kandel's observation of nicotine as a hyperacetylating agent predisposing to cocaine use should be an eye opener in terms of environmental agents having broad impact on the brain and there are studies in the works now looking at the epigenetic effects of trauma.<br /><br />I have never found psychometric test to be that interesting or in many cases valid. In Minnesota, I saw far too many young African American men and women of all ethnicities from traumatic backgrounds grossly misdiagnosed by the MMPI. And why would I expect any different? The MMPI was not designed to make diagnoses and I wonder about the sausage making necessary to get psychologists to suddenly adapt their technology to implement one that they are highly critical of. Seems like another conflict of interest to me. <br /><br /> I would be very concerned about a test trying to determine whether a person is psychotically depressed or not. <br /><br />Your bet about the markers not being here in my lifetime may be a safe bet.<br /><br />I am an old man and I could keel over at any time, but of course that knowledge won't ever prevent me from desperately clinging to life.<br /><br />G.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-2375583929717771332015-07-24T16:46:36.124-05:002015-07-24T16:46:36.124-05:00Genetic markers for depression and psychosis in ou...Genetic markers for depression and psychosis in our lifetimes will never be more valid nor more clinically useful than the top ten psychometric tests.<br /><br />Case in point: Someone with major depression denies suicidal ideation but many of the critical items on a valid PAI show high risk of suicide. Let's say same patient lacks hypothetical genetic combinations that indicate depression. So what now? We don't treat and we don't consider suicide risk?<br /><br />Hey I know some at NIMH want psychiatry to be as empirical as ophthalmology, but I don't see how that works in the real world. I really think they haven't thought it through.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.com