Our patients are among the most vulnerable.
As the director of social services for Majestic Care of Fort Wayne, a skilled nursing facility, I work with a team that specializes in long-term behavioral and psychiatric care. Many of our patients have been struggling with complex mental illnesses their entire lives and have taken multiple psychiatric medications. A lot of them have some form of developmental disablement.
I collaborate with mental health practitioners, including psychiatric nurse practitioners and physicians. They write the prescriptions and order the GeneSight test (I don’t order the GeneSight test). As a team, we’ve come to rely on the information that it gives our mental health practitioners to make patient treatment decisions.
Before the GeneSight test, our providers would try everything to stabilize our patients. They’ve tried old school medications. They’ve tried the new medication their guardian heard about on a TV ad last night.
So, our providers did a lot of prescribing via trial and error. They would change a medication or a dosage and then wait 14 to 21 days to see if it made an impact. During that time, we may encounter violent and unpredictable behavior from our residents. You just can’t play around with people’s medications like that.
So, when a representative from the GeneSight test told our team that the test might be able to help with medication prescribing, I was very skeptical. In our profession, you have to be skeptical. When you are part of a team that is treating patients who have depression, anxiety, Alzheimer’s disease, dementia, psychiatric bipolar disorder, schizophrenia – or any combination of those conditions – providers begin to feel like there can’t be a different way of treating than the trial-and-error method.
Standard of Care
GeneSight is now a standard of care at our facility, ordered by the prescribing members of the team.
When we are determining what is a good treatment plan for our patient, in addition to other factors, the providers review the results of the patient’s GeneSight test to determine what medication or dosage changes may help.
We are one of the few facilities that allow smoking in Fort Wayne, so some of our patients not only smoke currently, but some have been smoking for years. Because smoking can affect how certain medications may be broken down, smokers may need higher doses of those medications. So, if we know our patient is or has been a smoker, the team will pay close attention to the GeneSight report’s clinical consideration 7, which indicates that smoking may increase the metabolism of that medication. We wouldn’t have that information without the GeneSight test.
No Other Test Like It
There is no other test like it. We have so many examples of patients GeneSight has helped. We have a patient who suffers from numerous psychiatric conditions and, when he first came to us, he was taking nine different psychotropic medications.
Our providers ordered a GeneSight test because they knew we had to try to find a different medication regime for him. The report showed them that two of the meds indicated significant gene-drug interaction and others had some gene-drug interaction. The providers began the process of weening him off medications by reducing everything down to the lowest dose possible. Then, we let his body get used to that. Over a period of time, the providers methodically removed each of the problematic medications until he was only taking two psychotropic medications.
He is now more stable than before. He still needs some medication to calm him down when he gets occasionally violent. But he has come a long way.
We have another patient who was having electroconvulsive therapy (ECT) every single week in addition to taking many different medications. With the GeneSight test’s help, the providers reduced the number of medications she is taking – and she only to go to ECT every other week now. She is doing so much better.
You don’t always have success with everyone. But, in our world, if we can get one day where “Patient A” doesn’t scream or “Patient B” doesn’t hit, that’s a successful day.
This story is one clinician’s personal experience. Other experiences may vary.
As with all genetic tests, the GeneSight test results have limitations and do not constitute medical advice. The test results are designed to be just one part of a larger, complete patient assessment, which would include proper diagnosis and consideration of medical history, other medications being taken, family history, and other factors.
If you are a healthcare provider and interested in learning more about the GeneSight test, please call us at 855.891.9415. If you are a patient, please talk with your doctor to see if the GeneSight test may be helpful.