Researchers at the University of Cambridge have made significant strides in developing a blood-based metabolomic test that can help differentiate bipolar disorder from major depressive disorder. This test raises hope for reducing misdiagnoses, providing objective results in a field that heavily relies on patient self-reporting and symptomatic diagnosis. While the blood test can differentiate between these disorders in 30% of cases on its own, the accuracy increases to about 90% when combined with a patient evaluation using questionnaires.
Current Diagnostic Challenges:
Neuropsychiatric disorders are typically diagnosed using subjective evaluations based on patient-provided information, such as questionnaires. Treatment often involves a trial-and-error approach to find the right medication for each patient. While pharmacogenomic tests to guide treatments exist, their widespread adoption has faced skepticism, and regulatory challenges have arisen.
The Need for More Precise Tools:
The National Institutes of Health initiated a program, Individually Measured Phenotypes to Advance Computational Translation in Mental Health (IMPACT-MH), to develop more precise tools for diagnosing mood disorders and other psychiatric conditions. However, this program focuses on behavior- and activity-based measurements rather than in vitro diagnostics.
Bridging the Gap:
Diagnosing bipolar disorder accurately remains a challenge, with many individuals initially misdiagnosed as having depression. The average time to diagnose bipolar disorder is more than seven years in western countries. Treatment with antidepressants in bipolar disorder patients can lead to more manic episodes or inadequate responses, emphasizing the importance of accurate diagnosis.
Blood Test Development:
The blood-based metabolomic test was developed using mass spectrometry to identify predictive biomarkers of bipolar disorder. It provided accurate results when used in combination with patient evaluation data. Further studies are needed to validate results in larger and more diverse patient groups, optimize biomarker selection, examine the feasibility of combining test and questionnaire data, and meet regulatory requirements.
Commercialization Plans:
Psyomics, a spinout company from Cambridge led by Sabine Bahn, plans to develop the combination of the blood test and questionnaire-based patient evaluation into a commercial test. Initially, it will be available in the UK and later in the US, with FDA and European regulatory approvals planned for more widespread use.
Challenges in Diagnostic Test Development:
While progress is being made in the development of diagnostic tests for neuropsychiatric disorders, the field remains complex and challenging. Unlike oncology, which has tumor tests providing definitive answers, neuropsychiatric diagnoses rely on subjective assessments of human behavior and biomarker identification. Some companies and researchers are exploring various technologies, including genetic markers and immunoassays, to create more precise diagnostic tests.
Conclusion:
Developing accurate diagnostic tests for neuropsychiatric disorders remains a challenge, but recent advances, such as the blood-based metabolomic test, show promise. The continued exploration of diagnostic methods is essential to improve the accuracy of diagnoses and guide treatment decisions in the field of mental health.
