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Helps reduce the number of variables

Josh Sizemore, RN, MN, PMHNP-BC
Oregon

I’m known in Oregon for treating complex patient cases.

Many of the patients I see aren’t presenting with just one condition – they have multiple illnesses, developmental disabilities, and other physical or mental conditions. For example, I may see a patient who is between 15 and 25 years of age and has a psychiatric break. But this may be completely atypical, and so I need to figure out what is really going on.

There are always more people to treat than you could possibly have time for. Because I’m seeing patients with complex pictures, it is important for me to stabilize them as quickly as possible. I do a thorough assessment and use everything at my disposal to help my patients.

One of the tools I use is the GeneSight test.

Reducing the Number of Variables

When you are looking at a complex patient picture, you want to limit the number of variables. Especially in the case of severe mental illness – you are trying to narrow down and pinpoint what’s really going on and what you need to do. You just don’t have a lot of time for errors. Families will stick with you for a while, but results matter.

At the same time, conditions can be complex. For example, depression can be caused by 1,000 different things. My patient treatment philosophy is that we need to get to the root cause of depression, not just treat the diagnosis. I try to figure out the likeliest reason for depression: is it biological, genetic, conditional, or something else?

The GeneSight test helps me reduce some of the variables in treatment decisions.

After I order the GeneSight test, I will meet with the patient and their caregiver if appropriate to give them the results. I will NOT go through the GeneSight test results over the phone. It is much too complex. I take time to walk through the results report and share how to interpret the report. Further, I explain what’s important in the context of the entire medical assessment. When someone leaves my office, I share with them what they should hope to see, a timeline for medication response, and what they won’t want to see based on the medication.

Part of My Tools to Help Patients

I would say the GeneSight test helps me with my most vulnerable patients. For example, I had one highly ill patient who was on 13 different psychiatric meds when I first started seeing them, and still unstable even on that many medications. I was told by the locked, long-term facility where the patient was residing that the patient wouldn’t likely ever be stable enough to leave the facility.

I ordered a GeneSight test, and using the genetic testing results, I created a detailed medication plan reducing the number of medications that showed a genetic conflict. My new medication regime for the patient reduced the number of medications down to seven. The new medication regime started to work for the patient. They began to stabilize and, most importantly, the patient was discharged from long-term facility within a year.

If I were to talk to another clinician about the GeneSight test, I would tell them that if they want to increase their overall effectiveness and help patients get better, the GeneSight test may help them, as long as they can fully understand and interpret the report.

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