Laboratory & Diagnostic Testing in Psychiatry.
A labeled diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM) does not tell you anything about the cause of symptoms.
These subjective descriptions need to be evaluated objectively. The brain often recognizes changes in the body first because it is a very sensitive organ. Laboratory and diagnostic testing allows the Integrative Psychiatry specialist to look at relationships between the brain and the body to identify changes that may influence symptoms. This also gives your Integrative Psychiatry specialist a window into how external factors impact symptoms.
What follows are some of the common systems explored by an Integrative Psychiatry specialist and what testing may be included:
The Hypothalamic-Pituitary-Adrenal (HPA) Axis: This is the stress axis and is involved in managing cortisol, the stress hormone, and its impact on the brain. Many have unexamined and untreated stress axis abnormalities contributing to their symptoms. This is a common cause of sleep disturbances, irritability, muscle tension, difficulty focusing, and energy imbalances. General indicators of stress axis abnormalities can be picked up on general laboratory testing, such as sodium, potassium, and DHEA levels. Specialized testing shows how cortisol rises and falls throughout the day and guides treatment more effectively.
The Hypothalamic-Pituitary-Gonadal (HPG) Axis: This system manages pregnanolone, progesterone, estrogen, and testosterone, which all influence brain functioning. Imbalances tend to cause perimenstrual symptom correlation, loss of libido, and erectile dysfunction, among other things. Specialized testing shows how these hormones are balanced and metabolized.
The Gut-Brain Axis: The integrity of the gut lining, bacterial ecology, digestive and absorptive functioning, and liver detoxification all directly impact the brain. There is bidirectional communication between the brain and the gut. Additionally, the structure and function of the gut lining mirror the blood-brain barrier (separating the brain from the remaining internal environment). Those with a gut-brain axis abnormality tend to experience co-existing gut symptoms (e.g., nausea, diarrhea, constipation, irritable bowel syndrome, abdominal cramping, reflux, etc.) alongside psychiatric symptoms. Those who experience gut symptoms under stress or when anxious tend to have a problem here. Specialized testing shows a full breakdown of the activity of the gut lining, bacterial ecology, digestive and absorptive functioning, and liver detoxification.
The Hypothalamic-Pituitary-Thyroid (HPT) Axis and Metabolism: This axis is all about thyroid hormone. The thyroid maintains energetic activity. Low thyroid functioning causes fatigue, low energy, and depression. High thyroid functioning can cause irritability, anxiety, or even mania. As the major regulator of metabolism, the thyroid controls how we manage carbohydrates, fats, and proteins. Abnormalities in metabolism can sometimes be linked to thyroid abnormalities. However, it is uncommon for a general (or even specialist) medical provider to evaluate the full thyroid axis. Metabolic problems alone can cause mood dysregulation. Specialized testing shows full thyroid axis functioning, allowing for targeted treatment. By extension, metabolic testing can identify problems in metabolism that may cause your symptoms.
The Immune-Brain Axis: This axis represents the activities in the immune system and how they influence the brain. Inflammation, even when minor, can influence the brain's function. When inflamed, the brain cannot appropriately make neurotransmitters (such as serotonin, dopamine, and norepinephrine) effectively. Your body also will not respond to certain psychiatric medications when inflamed. Because of the wide implications of inflammation, this contributes to several psychiatric symptoms. Specialized testing shows the activity along the immune-brain axis, helping to navigate effective treatment options more effectively.
Epigenetics: While genes do not directly cause psychiatric illness, they make an individual vulnerable to psychiatric symptoms. Several genes related to the above systems can be examined using specialized testing. Once identified, we can modify gene activity with certain treatments. See more about Genetic Testing.
