Advanced Diagnostic Testing in Psychiatry.
When exploring the dynamics between the body and the mind, advanced laboratory and diagnostic testing brings objectivity into psychiatric practice. What’s more, utilizing a functional medicine approach by considering “functional” instead of “conventional” laboratory cutoffs and patterns assists in recognizing small perturbations that lead to clinically significant changes. The brain is a sensitive organ; therefore, changes in the body are often first recognized in the brain. In response, these changes contribute to the phenotypic expression of psychiatric illness that we encounter.
What follows are some of the advanced laboratory and diagnostic tests frequently incorporated in the Integrative Psychiatry approach:
Organic Acid Testing. Organic acid testing provides information about macronutrient and micronutrient activity, vitamins, gut ecology, gut immune activity, detoxification (including methylation), mitochondrial functioning, neurotransmitter metabolism, and immune activity. This comprehensive test provides general markers and is often used as an initial test to guide treatment. Significant abnormalities in organic acid testing will require further, more specialized testing. For instance, organic acid testing provides general markers reflecting the gut ecology and can support initiating a gut protocol for dysbiosis. However, specific microbes and associated sensitivity are not included and require comprehensive stool analysis. Organic acid testing can be completed through Genova (e.g., NutraEval or Metabolomix) and Mosaic Diagnostics (OAT).
Comprehensive Stool Analysis. Comprehensive stool analysis provides detailed information about absorption, digestion, gut ecology, and gut immune markers. The specific gut ecology and an appropriate culture and sensitivity for pathogenic or opportunistic organisms are detailed. This can serve as an effective starting place for those with significant coexisting psychiatric and gut symptoms but can also be used as a follow-up test for those with significant abnormalities on organic acid testing. Gut testing can be completed through the GI Effects test by Genova Diagnostics and the Comprehensive Stool Analysis by Doctor’s Data.
Hypothalamic-Pituitary-Adrenal (HPA) Axis Testing. Hypothalamic-pituitary-adrenal axis testing provides a breakdown of cortisol activity throughout the day. With these data, one can extract a curve of cortisol activity to identify dysfunction and adrenal fatigue. This testing is sometimes combined with neurotransmitter or hypothalamic-pituitary-gonadal axis testing. An analysis of the HPA axis can be completed through the DUTCH test by Precision Analytics, the NeuroAdrenal Profile by Doctor’s Data, or the Adrenocortex Stress Profile by Genova Diagnostics.
Neurotransmitter Testing. Neurotransmitter testing provides a breakdown of neurotransmitter activity so interventions can be targeted more efficiently. This testing is typically combined with hypothalamic-pituitary-adrenal axis testing. Neurotransmitter testing can be completed through the NeuroBasic or NeuroAdrenal Profile by Doctor’s Data. Organic acid testing, described above, helps to identify crucial vitamin and mineral imbalances necessary to support neurotransmitter synthesis and function.
Hypothalamic-Pituitary-Gonadal (HPG) Axis Testing. Hypothalamic-pituitary-gonadal axis testing provides a comprehensive breakdown of progesterone, testosterone, and estrogen metabolism, including an analysis of metabolic pathways. This testing may be combined with hypothalamic-pituitary-adrenal axis testing for a complete view of the steroidogenesis pathway. HPG axis testing can be completed through the DUTCH test by Precision Analytics or the One Day Hormone Check by Genova Diagnostics.
Genetic Testing. Genetic testing can be targeted to evaluate the pharmacodynamics and pharmacokinetics relevant to the use of psychotropics. Companies that provide this testing include Genomind, GeneSight, and Tempus. This serves as a useful guide for navigating psychotropic options. On the other hand, more comprehensive testing that examines several body systems can be achieved through 3x4 testing. This testing, unlike psychogenetic testing, focuses on nutraceutical and lifestyle modifications to support genetic abnormalities.
The Integrative Psychiatry Program (IPP), designed to guide clinicians through the implementation of Integrative Psychiatry, extensively covers advanced diagnostic testing. In my book, A New Way Forward, I also discuss advanced diagnostic testing, where I introduce the Integrative Psychiatry Matrix (IPM) as an approach to patient care in clinical practice.
