• Root Cause Analysis and Precision Psychiatry

     

    The only person you are destined to become is the person you decide to be.

    - Ralph Waldo Emerson

  • Root Cause Analysis and Precision Psychiatry

    “Knowing yourself is the beginning of all wisdom”

    Aristotle, 4th Century BC

    “In the twenty-first century… we are constructing a new epidemiology of self: we are beginning to describe illness, identity, affinity, temperament, preferences – and, ultimately, fate and choice – in terms of genes and genomes. The influence of genes on our lives and beings is richer, deeper, and more unnerving than we had imagined.”

    Siddhartha Mukherjee, M.D., 2016 AD

    Every single one of us deserves to live a happy, healthy, whole life.

    Imagine for a moment the complexity of your human body – that each of your 30 trillion human cells contains up to 2 trillion molecules – and that your body also contains 100 trillion bacterial cells (your microbiome) that continuously “talk to” those 30 trillion human cells – a vast and highly complex “molecular symphony” that constitutes your physical self. DNA resides inside each of those 130 trillion cells, and while human DNA is comprised of 25,000 genes, your microbiome contains 20 times that number!– 500,000 genes!

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      These genes are both the “composer” and “conductor” of that vast “symphony orchestra” that constitutes the life processes inside you. The human genome is truly awesome and complex, yet understanding and influencing the expression of your DNA is not just possible, it can change the way you think about your mental health. And understanding the role of your gut microbial genes in sickness and in health adds an additional critical dimension.

      Is your “symphony orchestra” playing beautiful music that coincides with health and happiness, or raucous noise that creates emotional distress?  The answer to this question relates to what is called “the epigenome,” which affects how those 525,000 genes inside you express themselves. The epigenome contains so-called “epigenetic influencers” (for example hormone levels, vitamin deficiencies, nutrient levels, stressful relationships, etc.) that regulate your genes by “turning them on” or “turning them off”  to produce the proteins and enzymes that control the function of all of your cells. Determining which epigenetic influencers contribute to emotional pain, and systematically correcting them, can profoundly influence your prospects for recovery.

      Our psychiatrists are continuously trained in the latest biotechnologies to evaluate and treat you as a Whole Person, to optimize the health of each and every one of those 130 trillion cells inside your body.

      We will do Whatever It Takes to help you feel well, recover your health, improve your relationships with others, and determine your destiny. We are driven to meticulously identify and precisely treat the underlying genetic and biological causes of emotional distress, the root causes of the emotional pain; persistently striving to help our patients achieve a full recovery.

      We Address the Root Causes of Your Emotional Pain

      Our psychiatrists use a functional medicine approach to promote mental wellness and prevent disease progression, by uncovering the root causes of your mental health concerns and systematically addressing each of them. We will do an in-depth assessment of the origins of your emotional distress, including cellular and microbiome-related contributors. We will not treat your symptoms in a trial-and-error fashion. Instead, using Personalized Precision Psychiatry, we focus on you instead of your disease by using personalized laboratory testing (including genetic, microbiome, and nutritional testing) to create a unique personal database of your underlying genetic and biologic vulnerabilities. And then, one-by one, we address each and every one of them.

      For example, we not uncommonly discover that a “leaky gut” predisposes to both acute and chronic mental health problems. As you can see in the infographic below, when the microbiome is unhealthy, incompletely digested foods and intestinal bacteria can leak into the bloodstream, promoting systemic inflammation, and what we call “leaky gut – leaky brain – leaky emotions.”

      If we uncover evidence of leaky gut, we will refer you to leading functional nutritionists to guide your diet and food intake to help restore mental wellness by replenishing nutrient deficiencies, healing the gut, and healing the brain. You may require more targeted interventions with specific foods in order to treat the underlying root causes of your mental health concerns.

      Below is a partial list of the tests we perform under an integrative medicine framework, to provide you Personalized Precision Psychiatry.

      Genetic Tests to Improve Mental Health and Brain Health

      Genomind Professional PGx

      This is a genetic test that analyzes 24 genes to inform treatment for many psychiatric conditions such as depression, anxiety, ADHD, bipolar disorder, etc. The information provided by this report is designed to help clinicians make more informed treatment decisions, and to help avoid the painful trial-and-error process usually involved in finding the right medication. The test is administered via a simple cheek swab collection. Specific genetic markers are analyzed to identify medications that are more likely to work effectively, have no effect, or cause a negative effect. For example, the test can show if the patient needs a higher or lower dosage of a certain medication or if a certain class of medication will be more or less effective. A summary of the value of this test can be found on our Mental Health Genes table, and by reading our blog series entitled, “DNA: I Am Who I Am… or Am I?”

      Genomind Mental Health Map

      This is a genetic test designed to help you understand your predispositions so that you can take new actions for your mental wellbeing. It tests 7 core genetic mental health capabilities: stress and anxiety, mood, focus and memory, substance abuse and habits, sleep, social behavior, and eating behavior. A clinician is not required to order this test and it does not inform medication decisions. It is administered via a simple cheek swab collection. The report comes with information about the genetics and neuroscience driving your behavior, tailored recommendations for people with your genotype, tools to improve your daily life based on genetic tendencies, and resources for finding the help you need. A summary of the value of this test can be found by reading our blog series entitled, “DNA: Nurture Your Nature.”

      Nutrient Evaluation to Improve Mental Health and Brain Health

      Genova’s nutritional evaluation test, the NutrEval FMV® is both a blood and urine test that evaluates over 125 biomarkers and assesses the body’s functional need for 40 antioxidants, vitamins, minerals, essential fatty acids, amino acids, digestive support, and other select nutrients. Personalized recommendations for nutrients are determined by using an algorithm based on the patient’s test findings, all in the service of correcting for nutritional deficiencies and optimizing cellular health. We work with leading nutritionists who understand both how to correct for these deficiencies, and how to create a diet that is personalized for you, to account for your preferences and tastes.

      Leaky Gut and Microbiome-Gut-Brain Axis Tests

      The value of these tests can be understood by reading our blog series entitled “Your Mighty Moody Microbiome,” and blogs related to “Inflammaging.”

      Genova GI Effects Comprehensive Stool Profile

      Gut inflammation and leaky gut are conditions that profoundly affect mental health. This test reveals important information about the root causes of many common gastrointestinal symptoms such as gas, bloating, indigestion, abdominal pain, diarrhea, and constipation. This test is administered via a stool sample. Additionally, the GI Effects test can be used to evaluate patients with a clinical history that suggests a gastrointestinal infection or dysbiosis. By examining biomarkers related to maldigestion, inflammation, dysbiosis, metabolite imbalance, and infection, this test offers valuable insight into digestive function, intestinal inflammation, and the intestinal microbiome, including biomarkers predisposing to leaky gut syndrome.

      Genova Allergy Antibody Test

      Food antigens trigger inflammation throughout the body, including brain inflammation. The IgG Food Antibody Assessment measures antibodies to 87 commonly consumed foods to test allergic reactions, including IgE and IgG antibodies. This test is administered via bloodwork. Testing for adverse food reactions is useful for individuals who suspect that a food is responsible for causing their symptoms but cannot quite identify which food(s). The presence of circulating antibodies may affect each patient differently, as circulating IgG food antibodies indicate a certain immune response to that food. Removal of the reactive foods often results in resolution of symptoms.

      Cyrex Arrays

      Many psychiatric conditions have an immunologic component to them that either causes the symptoms or worsens them. Thus, many patients struggling with mood or anxiety disorders actually suffer from an immune system disorder. These tests focus on immunity tests and autoimmune diseases triggered by environmental factors. They are administered via blood-draw. A commonly used test is the Intestinal Antigenic Permeability Screen, which measures intestinal permeability to large molecules that inflame the immune system and identifies the damaging route through the intestinal barrier. Additionally, the Wheat/Gluten Proteome Reactivity and Autoimmunity Test helps identify possible Celiac disease, non-celiac gluten sensitivity, or other wheat/gluten-related disorder by assessing autoimmune reactivity associated with wheat proteins and peptides. Finally, the Multiple Autoimmune Reactivity Screen measures predictive antibodies, some of which can appear up to 10 years before the clinical onset of disease. This efficiently assesses possible tissue damage to multiple organs of the body.

      KBMO’s Food Inflammatory Test (FIT)

      This finger stick test is a multi-pathway delayed food sensitivity test that uses new technology to measure both IgG and Immune Complexes, the most common food-related inflammatory pathways in the body. This is the first assay to identify both IGG1-4 and C3d simultaneously, and includes a determination of the inflammation markers for up to 176 foods, colorings, and additives spanning all major food groups. This includes dairy, grains, fruits, vegetables, beans, fish, meets, spices, etc. Based upon the test results, one can reduce systemic inflammation by personalizing a patient’s diet to help alleviate symptoms in patients suffering from depression, bipolar disorder, anxiety disorders, OCD, and ADHD. Food elimination based on the FIT Test helps our practitioners get to another possible root cause of the negative emotional symptoms that you are experiencing, that have not fully responded to medication or psychotherapy, and systematically correct them to further your recovery.

      Other Laboratory Tests

      Urine Drug Screen

      The urine drug screen is used for addiction and substance abuse treatment plans. It is a simple urine collection that tests for compounds such as amphetamines, barbiturates, cannabinoids (THC), cocaine metabolite, methadone, opiates, etc. to ensure that treatment is working. The frequency varies according to the patient, from weekly, to monthly, to as needed.

      Screening Laboratory Testing

      There are a large variety of lab tests that can be ordered via LabCorp or Quest to help your psychiatrist or psychologist best treat you. These tests are used to monitor treatment to see if a medication is working properly as well as to rule out other underlying conditions such as vitamin deficiencies, hormone imbalances, or inflammatory conditions. For example, the results can give important information about the current status of your body’s metabolism, blood sugar levels, balance of electrolytes, blood cell count, etc. in order to evaluate overall health and wellbeing. This information is taken into account when prescribing medication and forming an effective treatment plan. It can also help inform recommendations for leaky gut, microbiome, nutritional, or food sensitivity testing noted above.

      Our offices are conveniently accessible from the following communities:

      Maryland (MD):
      Bethesda 20814 - Bethesda 20816 - Bethesda 20817 - Chevy Chase 20815 - Colesville 20904 - Cabin John 20815 - Glen Echo 20812 - Gaithersburg 20855 - Gaithersburg 20877- Gaithersburg 20878 - Gaithersburg 20879 - Garrett Park 20896 - Kensington 20895 - Montgomery Village 20886 - Olney 20830 - Olney 20832 - Potomac 20854 - Potomac 20859 - Rockville 20850 - Rockville 20852 - Rockville 20853 - Silver Spring 20903 - Silver Spring 20905 - Silver Spring 20906 - Silver Spring 20910 - Takoma Park 20912 - Wheaton 20902

      Washington DC:
      Crestwood 20011- North Capitol Hill 20002 - Cathedral Heights 20016 - American University Park 20016 - Columbia Heights 20010 - Mount Pleasant 20010 - Downtown 20036 - Dupont Circle 20009 - Logan Circle 20005- Adams Morgan 20009 - Chevy Chase 20015 - Georgetown 20007 - Cleveland Park 20008 - Foggy Bottom 20037 - Rock Creek Park - Woodley Park 20008 - Tenleytown 20016

      Northern Virginia:
      McLean 22101- McLean 22102 - McLean 22106 - Great Falls 22066 - Arlington 22201 - Arlington 22202 - Arlington 22203 - Arlington 22205 - Falls Church 22041 - Vienna 22181 - Alexandria 22314