How is the diagnosis made? Although bipolar disorder is a biological disease, there are no laboratory tests or other procedures a clinician can use to make a firm diagnosis. Instead, the clinician makes the diagnosis based on a group of symptoms that occur together. To make an accurate diagnosis, the clinician needs to take a careful history from the person who is ill and, if possible, from family members. The clinician will want to know about symptoms the person is currently having as well as any symptoms he or she had in the past.

http://www.psychguides.com/Bipolar%20Handout.pdf

Snake Phobias, Moodiness and a Battle in Psychiatry By BENEDICT CAREY Published: June 14, 2005

Psychiatrists have been searching for more than a century for some biological marker for mental disease, to little avail. Although there is promising work in genetics and brain imaging, researchers are not likely to have anything resembling a blood test for a mental illness soon, leaving them with what they have always had: observations of behavior, and patients' answers to questions about how they feel and how severe their condition is.

http://www.nytimes.com/2005/06/14/health/psychology/14ment.html?ei=5088&en=74e5 2f96fa597af6&ex=1276401600&adxnnl=1&partner=rssnyt&emc=rss&adxnnlx=1158188 603-5eQhjdZ612DFeTBCw/2Zag

Metabolic Profiling of CSF: Evidence That Early Intervention May Impact on Disease Progression and Outcome in Schizophrenia Elaine Holmes, Tsz M. Tsang, Jeffrey T.-J. Huang, F. Markus Leweke, Dagmar Koethe, Christoph W. Gerth, Brit M. Nolden, Sonja Gross, Daniela Schreiber, Jeremy K. Nicholson, Sabine Bahn 1 Biological Chemistry, Biomedical Sciences Division, Faculty of Medicine, Imperial College, London, United Kingdom, 2 Institute of Biotechnology, University of Cambridge, Cambridge, United Kingdom, 3 Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany

Introduction The current diagnosis of schizophrenia remains subjective, not only because of the complex spectrum of symptoms and their similarities to other mental disorders, but also due to the lack of empirical disease markers. There is a great clinical need for diagnostic tests and more effective drugs for the treatment of severe mental illnesses.

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0030327

Potential Biomarkers for Schizophrenia 24 Aug 2006

Schizophrenia is a disease for which no "objective" biological test exists. The current diagnosis is based on the symptoms experienced and reported by the patient, in combination with signs observed by a psychiatrist, clinical psychologist, or other clinician.

http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=50222

Schizophrenia, bipolar disorder, Autism Spectrum Disorder, dyspraxia, dyslexia, depression and Attention Deficit Hyperactivity Disorder – they've all got their names, but it's surprising how little else we know about the vast majority of mental disorders. With no biological way of diagnosing them, we have to rely on clinical assessment, which isn't always accurate and can only poorly predict the course of the illness. It's reassuring to discover therefore that, as with so many other important fields, Scottish universities are at the forefront of psychiatric research, finally pushing back the boundaries in an area where there have been few significant breakthroughs in the last 50 years. Their main areas of activity can be divided into two parts – diagnostic research and the development of new treatments.

http://www.friendsofscotland.gov.uk/education/psychiatry.html

We should avoid mental health insurance Nov, 1994 by Richard E. Vatz, Lee S. Weinberg

How accurate are such diagnoses? In actuality, there is no way to assess the accuracy of diagnoses of mental illnesses, which are defined in terms of behaviors and feelings, not measurable, physical abnormalities, and thus can not be challenged for validity. That is why, when psychiatrists say their diagnoses are accurate, they point to diagnostic "reliability" as proof. In this case, reliability means only that practitioners use the same categories to describe the same types of mental or behavioral problems. With no medical measures or tests to disconfirm mental illness diagnoses, psychiatric estimations of the incidence of mental illness seem to be boundless. Indeed, in 1994, the previous year's monumental figures were trumped again. Yet another new survey on the prevalence of mental illness published in the beginning of 1994 in the Archives of General Psychiatry claims that nearly 50% of all Americans will be mentally ill at some point during their lives.

http://www.findarticles.com/p/articles/mi_m1272/is_n2594_v123/ai_15897230

The diagnosis of mental disorders is often believed to be more difficult than diagnosis of somatic, or general medical, disorders, since there is no definitive lesion, laboratory test, or abnormality in brain tissue that can identify the illness. The diagnosis of mental disorders must rest with the patients’ reports of the intensity and duration of symptoms, signs from their mental status examination, and clinician observation of their behavior including functional impairment. These clues are grouped together by the clinician into recognizable patterns known as syndromes. When the syndrome meets all the criteria for a diagnosis, it constitutes a mental disorder. Most mental health conditions are referred to as disorders, rather than as diseases, because diagnosis rests on clinical criteria. The term “disease” generally is reserved for conditions with known pathology (detectable physical change). The term “disorder,” on the other hand, is reserved for clusters of symptoms and signs associated with distress and disability (i.e., impairment of functioning), yet whose pathology and etiology are unknown.

http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec2.html

DSM-IV is descriptive in its listing of symptoms and does not take a position about underlying causation.

http://www.surgeongeneral.gov/library/mentalhealth/chapter2/sec2.html

Genetics and Mental Disorders In sickle-cell anemia, for instance, experts and non-experts can look through a microscope and see if the specific deformation of the blood cell - and therefore the disease - is present. For mental disorders, however, no clear biological test has been found. Further, investigators have had trouble discriminating specific forms of mental disorders, such as distinguishing someone experiencing depression as part of a depressive disorder from someone experiencing depression as part of bipolar disorder (also called manic-depressive disorder). Single, causative genes, such as those resulting in sickle-cell anemia or Huntington's disease, do not explain how mental disorders affect one out of five Americans. Instead, researchers now believe that several susceptibility genes interact with each other and with environmental factors to influence the risk of developing a particular disorder. Finding the susceptibility genes amid multiple environmental factors is a formidable task, but not unique to mental disorders.

http://psychiatry.mc.duke.edu/CMRIS/ed/EDpdf/Genetics%20and%20Mental%20Illness.pdf

Can Brain Scans See Depression? By BENEDICT CAREY Published: October 18, 2005

After almost 30 years, researchers have not developed any standardized tool for diagnosing or treating psychiatric disorders based on imaging studies. "The thing for people to understand is that right now, the only thing imaging can tell you is whether you have a brain tumor," or some other neurological damage, said Paul Root Wolpe, a professor of psychiatry and sociology at the University of Pennsylvania's Center for Bioethics.

PROMISING, NOT YET PRACTICAL Researchers have scanned the brains of patients with illnesses including depression, schizophrenia and attention deficit disorder, hoping to find patterns. But so far, scanning has not yielded reliable ways to diagnose or treat disorders.

http://www.nytimes.com/2005/10/18/health/psychology/18imag.html?pagewanted=1&ei =5088&en=623b95b778748ffa&ex=1287288000&partner=rssnyt&emc=rss

Still, brain science has not advanced to the point where scientists or clinicians can point to readily discernible pathologic lesions or genetic abnormalities that in and of themselves serve as reliable or predictive biomarkers of a given mental disorder or mental disorders as a group. In the absence of one or more biological markers for mental disorders, these conditions are defined by a variety of concepts. These include the distress experienced and reported by a person who has a mental disorder; the level of disability associated with a particular condition; patterns of behavior; and statistical deviation from population-based norms for cognitive processes, mood regulation, or other indices of thought, emotion, and behavior.

http://psych.org/news_room/press_releases/mentaldisorders0339.pdf#search=%22biologi cal%20test%20for%20mental%20illness%22

Attention Deficit Hyperactivity Disorder (ADHD), the most commonly diagnosed childhood psychiatric disorder, is also one of the most controversial diagnoses in the area of mental health. Q: How is ADHD diagnosed? A: As with many mental health and psychiatric disorders, there is no definitive biological test for ADHD--such as a blood test or a brain scan. This makes diagnosing the disorder difficult. For example, a child made extremely anxious by a traumatic or stressful situation may exhibit behaviors that could be mistaken for ADHD. In addition, ADHD is often found in children with other psychiatric disorders--including depression or a learning disorder--further complicating diagnosis. A thorough diagnosis for ADHD should involve a team of professionals including a healthcare practitioner, speech therapist and occupational therapist, as well as input from parents and teachers. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) provides diagnostic standards for ADHD.

http://149.48.228.121/wgbh/pages/frontline/shows/medicating/etc/guide.html

PEDIATRIC PERSPECTIVE

Health care system leaves mentally ill children behind By Dr. Darshak Sanghavi April 27, 2004

In 2000, Massachusetts passed the Mental Health Parity Law, which guarantees coverage (and continues to allow carve-outs) for roughly 10 "biologically-based" mental illnesses, including schizophrenia, major depression, and obsessive-compulsive disorder. This was good for many patients who lacked any guarantees of coverage. But it excluded eating disorders, drug addiction, and others conditions determined not to be "biologicallybased." This makes little sense. First, despite pseudoscientific terms like "chemical imbalance," nobody really knows what causes mental illness. There's no blood test or brain scan for major depression. No geneticist can diagnose schizophrenia. Second, illness severity doesn't correlate with being "biologically-based." Shockingly, one in 10 anorexics dies from the disease, but anorexics still don't get equal treatment. Finally, if you try hard enough, you can find a "biological basis" for any behavior; for example, having a Y-chromosome predicts whether a teenager likes pro wrestling.

http://www.boston.com/news/science/articles/2004/04/27/health_care_system_leaves_me ntally_ill_children_behind?mode=PF

The Journal of Mind and Behaviour Spring 2001, Volume 22, Number 2 Pages 161-178

The Concept of Mental Illness: An Analysis of Four Pivotal Issues

Robert Woolfolk Princeton University

Although mental illnesses supervene on biological processes, these processes are complex and poorly understood. Despite the public relations clout of an effective biomedical lobby bankrolled by an affluent multinational pharmaceutical industry, the claim that mental illnesses have been shown to result from straightforward metabolic imbalances has not been substantiated. There is no biological laboratory test for any mental illness that confirms or disconfirms a diagnosis derived from a clinical interview. The clinical interview continues to be the diagnostic "gold standard." No biological theory of etiology for any of the major disorders has been confirmed by empirical research. For a given disorder, effective somatic treatments, invariably, are motley sets with heterogeneous mechanisms of actions and frequent unwelcome, harmful effects.

http://www.academicarmageddon.co.uk/library/ment.htm

Information about Mental Illness and the Brain 4.2 Mental Illnesses are Diagnosed by Symptoms

Unlike some disease diagnoses, doctors can’t do a blood test or culture some microorganisms to determine whether a person has a mental illness. Maybe scientists will develop discrete physiological tests for mental illnesses in the future; until then, however, mental health professionals will have to diagnose mental illnesses based on the symptoms that a person has. Basing a diagnosis on symptoms and not on a quantitative medical test, such as a blood chemistry test, a throat swab, X-rays, or urinalysis, is not unusual.

http://science-education.nih.gov/supplements/nih5/mental/guide/info-mental-a.htm

Overdiagnosis of ADHD in Children Melissa A. Armer Rochester Institute of Technology The problem with diagnosing ADHD is that there is no biological test for the disorder. Being inattentive, hyperactive, and impulsive in a way are the characteristics of being a kid. There is no clear line between typical and severe behavior--it is totally up to the doctor to decide.

http://www.personalityresearch.org/papers/panko.html

Lesson 2—Explore/Explain What’s Wrong? Activity 3: Observing the Depressed Brain

In this activity, students examine one way that scientists study what happens to the brain in depression. Emphasize to students that neuroscientists use imaging techniques such as PET in research studies that are conducted with adult volunteers. These techniques are not used clinically to diagnose depression or other mental illnesses, nor are they generally used with children, even in research settings. For more about the use of PET and other imaging techniques, see Section 5.2 Investigating Brain Function in Information about Mental Illness and the Brain. As necessary during this activity, remind students that PET and other imaging tests are used for scientific research and not for clinical diagnosis or treatment.

http://science.education.nih.gov/supplements/nih5/mental/guide/lesson2b.htm

Current ways of classifying disorders, such as the DSM-IV approach based on disease syndromes with arbitrary cutoffs, may have to be rethought. For example, the DSM-IV uses the term major depression to refer to episodic, primary, unipolar depression of adequate severity. There is no definitive biologic marker for this disorder, nor are there pathognomonic symptoms. The diagnosis therefore is made using a set of criteria based on clinical observation. The DSM-IV criteria almost certainly represent an etiologically heterogeneous group of patients; moreover, the criteria arbitrarily create cutoffs or thresholds on continuous functions (for example, requiring two weeks’ duration).

http://content.healthaffairs.org/cgi/reprint/18/5/32.pdf#search=%22mental%20illness%20biological%20marker%22

Open Forum

The Medicalization of the Human Condition Paul Chodoff, M.D. What is needed and what is still lacking is some kind of biological marker, such as tissue alterations or a serologic or imaging abnormality, that can distinguish, say, a clinical depression from a state of unhappiness. Such biological markers are available in other branches of medicine but not in psychiatry, except to a very limited degree. It is also true that most people who have depression, clinical or not, have other problems and concerns that affect their feelings and will influence the criteria by which they are diagnosed.

PSYCHIATRIC SERVICES ♦ May 2002 Vol. 53 No. 5

http://psychservices.psychiatryonline.org/cgi/content/full/53/5/627

Evidence-Based Practices: Shaping Mental Health Services Toward Recovery Illness Management and Recovery Workbook Handout 2b: Practical Facts About Bipolar Disorder

How is bipolar disorder diagnosed? Bipolar disorder is diagnosed based on a clinical interview conducted by a specially trained professional, usually a doctor, but sometimes a nurse, psychologist, social worker or other mental health practitioner. In the interview, there are questions about symptoms you have experienced and how you are functioning in different areas of your life, such as relationships and work. There is currently no blood test, X-ray or brain scan that can be used to diagnose bipolar disorder. To make an accurate diagnosis, however, the doctor may also request a physical exam and certain lab tests or blood tests in order to rule out other causes of symptoms, such as a brain tumor or an injury to the brain.

http://www.mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/illness/workbook/ handout2b.asp

Evidence-Based Practices: Shaping Mental Health Services Toward Recovery Illness Management and Recovery Workbook Handout 2a: Practical Facts about Schizophrenia How is schizophrenia diagnosed? Schizophrenia is diagnosed based on a clinical interview conducted by a specially trained professional, usually a doctor, but sometimes a nurse, psychologist, social worker or other mental health practitioner. In the interview, there are questions about symptoms you have experienced and how you are functioning in different areas of your life, such as relationships and work. There is currently no blood test, X-ray, or brain scan that can be used to diagnose schizophrenia. To make an accurate diagnosis, however, the doctor may also request a physical exam and certain lab tests or blood tests in order to rule out other causes of symptoms, such as a brain tumor or an injury to the brain.

http://www.mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/illness/workbook/ handout2a.asp

Background Definition As yet, there is no biological test (such as a blood test) for depression.

http://www.bcbsm.com/foundation/pdf/depression_2006.pdf#search=%22%22biological %20test%22%20mental%20illness%22

Many professional and lay people today think depression can be caused by "chemical imbalance" in the brain even though none of the "chemical imbalance" theories of depression have been verified. Some of them are discussed by Dr. Andreasen in her book The Broken Brain. In 1993 in her book If It Runs In Your Family: Depression, Connie S. Chan, Ph.D., acknowledges that "There is still no valid biological test for depression" U.S. Congress Office of Technology Assessment reported in 1992 that "Prominent hypotheses concerning depression have focused on altered function of the group of neurotransmitters called monoamines (i.e., norepinephrine, epinephrine, serotonin, dopamine), particularly norepinephrine (NE) and serotonin. ... studies of the NE [norepinephrine] autoreceptor in depression have found no specific evidence of an abnormality to date. Currently, no clear evidence links abnormal serotonin receptor activity in the brain to depression. ... the data currently available do not provide consistent evidence either for altered neurotransmitter levels or for disruption of normal receptor activity" (The Biology of Mental Disorders, U.S. Gov't Printing Office, 1992, pp. 82 & 84). "...there are no clinical tests for the 'chemical imbalances' that may contribute to depression." Harvard Men's Health Watch (published by Harvard Medical School) December 1998, page 6 (underline added). "A serotonin deficiency for depression has not been found. ... Still, patients are often given the impression that a definitive serotonin deficiency in depression is firmly established. ... The result is an undue inflation of the drug market, as well as an unfortunate downplaying of the need for psychological treatments for many patients." Joseph Glenmullen, M.D., clinical instructor in psychiatry at Harvard Medical School, in his book Prozac Backlash (Simon & Schuster, New York, 2000), pages 197-198.