A New Blood-Based Diagnostic Aid for Schizophrenia

An letter to the editor published in the September 2011 edition of Psychiatric Services:

To the Editor: Many people with schizophrenia exhibit poor insight into and lack of acceptance of their illness (1,2). The absence of objective proof of this disease contributes to this problem. Investigators have been interested in developing a blood-based biomarker test to help identify a biological signature to aid in diagnosis of schizophrenia, particularly in the prodrome of the illness (3,4).

Such a test has recently been developed, validated, and marketed in the United States. This test, VeriPsych, uses a multiplex immunoassay technology that profiles a proprietary disease signature comprising 51 analytes. The test has been found to be 83% sensitive and specific in distinguishing persons with schizophrenia from those without the disorder; the study in which the test's validity was established included more than 500 patients in the development phase and more than 800 patients in the validation phase (5). However, little has been subsequently published about this test, and its clinical utility remains unclear.

Our treatment team administered the test to a 30-year-old woman with a five-year history of schizophrenia who did not accept the fact that she had schizophrenia and who had problems remaining adherent to antipsychotic medications. The test yielded a positive result for the diagnosis of schizophrenia (score of –9199), with a conditional probability score that indicated a 95% chance of having the illness. After being informed of these results, our patient began to accept that her symptoms could be attributed to schizophrenia. For the first time, she expressed interest in learning about schizophrenia, acknowledged a personal connection to her family history of the disorder, and accepted her need of antipsychotic medications. Her therapeutic alliance with her psychiatrist and treatment team has improved, she has enrolled in a college-level class, and her attitude toward antipsychotic treatment remains positive. Her psychiatrist notes that this remarkable change was the result of her confidence in the blood test results—for the first time she had objective data about her illness.

Improving insight and illness acceptance among patients with schizophrenia has proven to be no small task. Psychoeducation, meta-cognitive training, cognitive therapy, and family intervention aimed at developing an understanding and acceptance of schizophrenia have shown only some success (1). Our interest in the test was not to confirm a clinical diagnosis of schizophrenia but to help a patient with schizophrenia accept her illness. We feel that if this test or future serum tests are more widely utilized, then their use as an aid in helping people who have no illness insight or who lack acceptance of their illness may be an important application. We hope that our letter will bring attention to this new test and encourage further research to replicate and validate our results. We also need to develop a better understanding of the clinical and research uses of this blood-based diagnostic aid and of its potential role and place in the treatment of patients with schizophrenia.

Deanna L. Kelly, Pharm.D., B.C.P.P., Sheryl Thedford, Pharm.D. and Gopal Vyas, D.O.

Dr. Kelly is affiliated with the Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore.

When the test was administered, Dr. Thedford was with the Department of Pharmacy Practice, School of Pharmacy, University of Maryland. She is now with the Bernard J. Dunn School of Pharmacy, Shenandoah University, and the Pharmacy Department, Winchester Medical Center, Winchester, Virginia.

Dr. Vyas is with Spring Grove Hospital Center, Baltimore.

Acknowledgments and disclosures

Rules Based Medicine supplied the VeriPsych test but had no involvement in the use of the test, the results, or publication.

The authors report no competing interests.

References

1. Lysaker PH, Buck KD, Salvatore G, et al: Lack of awareness of illness in schizophrenia: conceptualizations, correlates and treatment approaches. Expert Review of Neurotherapeutics 9:1035–1043, 2009 [CrossRef][Medline]
2. Buckley PF, Wirshing DA, Bhushan P, et al: Lack of insight in schizophrenia: impact on treatment adherence. CNS Drugs 21:129–141, 2007 [Medline]
3. Schwarz E, Guest PC, Rahmoune H, et al: Identification of a biological signature for schizophrenia in serum. Molecular Psychiatry epub ahead of print PMID , 2011 [Medline]
4. Dudley E, Hassler F, Thome J: Profiling for novel protemonics biomarkers in neurodevelopmental disorders. Expert Review of Proteomics 8:127–136, 2011 [CrossRef][Medline]
5. Schwarz E, Izmailov R, Spain M, et al: Validation of a blood-based laboratory test to aid in the confirmation of a diagnosis of schizophrenia. Biomarker Insights 5:39–47, 2010 [Medline]

Empirical Support for the Family-to-Family Program

From the This Month's Highlights section of the June 2011 edition of Psychiatric Services:

Family- and consumer-driven care is at the center of a transformed system. Family members play important roles in the lives of most adults with serious mental illness. They need information and skills to help their loved one, as well as the support of others to fulfill their caregiver role without being overwhelmed by distress and burden. The Family-to-Family Education Program (FTF), introduced in the early 1990s by the National Alliance on Mental Illness, is the most widely disseminated mutual-support program for family members of people with mental illness.

Although an estimated 250,000 family members have participated in FTF, little research has focused on family selfhelp. In the lead article this month, Lisa B. Dixon, M.D., M.P.H. [pictured], and colleagues report the results of the first randomized controlled trial of the effectiveness of FTF, which involved assignment of 318 family members from five Maryland counties to FTF or a waiting list. At three months (course termination), FTF participants had significantly greater improvements in problem-focused coping, as measured by empowerment and illness knowledge. Their emotion-focused coping was also significantly enhanced, and they had less distress and better problem- solving skills. These empirical findings confirm the word-of-mouth popularity of FTF among participants, the authors note, and provide support for consideration of brief family-driven educational programs as an evidence-based practice (page 591).

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Also see:

Strengthening Families Together

Housing affordability crisis for people with disabilities

A news brief from the June 2009 edition of Psychiatric Services:

In 2008 the national average rent for a modest one-bedroom unit reached $749 per month, according to the U.S. Department of Housing and Urban Development (HUD). For the more than four million people with disabilities who rely on Supplemental Security Income (SSI), this figure exceeds their entire average monthly income of $668.

Rising rents are not the only factor in the housing affordability crisis. Annual income for a person on SSI is $8,016, which has fallen to 18.6% of the national median income for a single-person household and is 30% below the federal poverty level for an individual.

The crisis is described in a new report Priced Out in 2008, the latest in a series published every two years by the Technical Assistance Collaborative (TAC) and the Consortium for Citizens With Disabilities (CCD) Housing Task Force. In 1998, when the first report was issued, there were 44 housing market areas in 13 states where a person on SSI would have to pay more than his or her monthly income for a one-bedroom unit. Ten years later, this was the case in 219 housing market areas across 41 states. The report also describes signs of progress, including 2009 legislation that creates a new National Affordable Housing Trust Fund and that includes tens of billions of dollars in housing relief through changes to the Low Income Housing Tax Credit program and commitments of capital funds to public housing. The 47-page report, which was funded by the Melville Charitable Trust, is available at www.tacinc.org.

Also see:

Supportive Housing