By Jerald Kay. MD. December 2017 issue of the Psychiatric Times.
A few points regarding the articles presented:
1. On the Roy-Berne et al. article on “highlighting the myth of precision psychiatry”. I think Dr Kay and others need to have a long-term perspective. While genetic testing is a science in the embryo stage, it is not completely a myth. See this incredible study below. We need to be patient as this kind of science moves forward in the next 100-200 years-but it is not myth.
A population-based study of KCNH7 p.Arg394His and bipolar spectrum disorder. Hum Mol Genet. 2014 Dec 1; 23(23): 6395–6406. Strauss, et al.
From the abstract:
“We conducted blinded psychiatric assessments of 26 Amish subjects (52 ± 11 years) from four families with prevalent bipolar spectrum disorder, identified 10 potentially pathogenic alleles by exome sequencing, tested association of these alleles with clinical diagnoses in the larger Amish Study of Major Affective Disorder (ASMAD) cohort, and studied mutant potassium channels in neurons. Fourteen of 26 Amish had bipolar spectrum disorder. The only candidate allele shared among them was rs78247304, a non-synonymous variant of KCNH7 (c.1181G>A, p.Arg394His). KCNH7 c.1181G>A and nine other potentially pathogenic variants were subsequently tested within the ASMAD cohort, which consisted of 340 subjects grouped into controls subjects and affected subjects from overlapping clinical categories (bipolar 1 disorder, bipolar spectrum disorder and any major affective disorder). KCNH7 c.1181G>A had the highest enrichment among individuals with bipolar spectrum disorder (χ2 = 7.3) and the strongest family-based association with bipolar 1 (P = 0.021), bipolar spectrum (P = 0.031) and any major affective disorder (P = 0.016). Although our genome-wide statistical results do not alone prove association, cumulative evidence from multiple independent sources (parallel genome-wide study cohorts, pharmacological studies of HERG-type potassium channels, electrophysiological data) implicates neuronal HERG3/Kv11.3 potassium channels in the pathophysiology of bipolar spectrum disorder.”
- On the Leichsenring F, et al. article on comparing CBT with psychodynamic therapy.
Any head-to-head comparisons are necessarily unblinded, neither patients nor therapists can be blind, there is no blind-placebo comparator either, and there is no way to filter out patient preference or treater bias. All the study endpoints are subjective and there is no way to robustly and logically compare these modalities as there is some improvement seen in every group that has some expectation and hope and receives a helping hand. Conclusion: these studies are a non-inferiority examination of subjective parameters of a human condition leading to no possible scientific conclusion.
- On the Fonagy et al. paper, there is no proof that Relational theory is better or worse than CBT or neuroscience in describing psychopathology. This paper is clearly opinion and conjecture, and should be stated to be so.
- On the Cabitza et al. paper questioning machine learning for medical care. Perhaps this is true in psychiatry, but for a field like oncology, it is clearly better to have a machine on your team:
“IBM has collaborated with several cancer care providers to develop and train the IBM supercomputer Watson to help clinicians make informed treatment decisions. When a patient is seen in clinic, the oncologist can input all of the clinical information into the computer system. Watson will then review all of the data and recommend treatment options based on the latest evidence and guidelines. Once the oncologist makes the treatment decision, this information can be sent directly to the insurance company for approval. Watson has the ability to standardize care and accelerate the approval process, a benefit to the healthcare provider and the patient”.
Doug Berger MD, Ph.D.
US Board-Certified Psychiatrist
For more information about Douglas Berger Psychiatrist Tokyo visit the following websites: