Testing and Neuroimaging for Youth at Risk for Mental Illness: Trading off Benefit and Risk

I think there would be more compassion for what the patient is enduring. Because with many mental health diagnoses, let’s just say depression as an example, I think there’s a lack of compassion that people seem to feel you can snap out of it. But having a brain scan to indicate this is not the patient’s fault it’s something that is going on in the body. And, I think it would be helpful for all of us to have a clearer understanding, to help us appreciate that, you know, these changes are very real (Participant #006, Registered Nurse).

Because the doctors will have some confidence about what they’re showing, the modality that they’re using is important and worth the time and the money that’s involved (Participant #103, Psychiatrist).

[Brain imaging] would give a clinician a lot of information about the illness and the condition at hand and its response to the treatment. And it will be a very important addition to other kinds of clinical information gathered through other avenues or other techniques (Participant #107, Psychiatrist).

[Genetic testing] would clarify what they’re experiencing. It would just reify it. The disorders in psychiatry and psychology are distorted; [they] are right now, currently, clusters of symptoms . . . So, this would make it more concrete, and that would, actually, really change the nature of the psychiatric diagnostic because it would all of a sudden have something concrete. That could be the defining thing about whether a disorder exists or not (Participant #048, Psychologist).

Sometimes just having a name to be able to put to what’s going on, sometimes just that is a relief. I think it’s also a relief because knowing what it is, whether this is true or not, but knowing what it is feels like (Participant #044, Counselor).

For some clients, having information about their genes may be—they may feel more normalized, they may understand their symptoms better, they might feel, you know, “okay, now I understand why things are the way they are.” Versus other people [who] may not believe in that (Participant #055, Counselor).

So, if there could be some definitive test that says, “Yes, this child really has the brain characteristics of what you see in bipolar disorder.” If that were identified, it would be helpful, I think, in treatment for sure—choosing the appropriate medications and kind of overall treatment planning. So that would be terrific to have (Participant #111, Psychiatrist).

Well I think one of the biggest confounding factors is for us to have a more universal understanding of what diagnosis is. So maybe this would actually help us, by having imaging, because there’s so much controversy of how to frame diagnosis . . . So perhaps neuroimaging would actually help resolve that (Participant #125, Psychiatrist).

I think it would have good impact in that there would be some public health benefit to early diagnosis, early case findings, and in terms of preventing worsening of disorders (Participant #120, Psychiatrist).

Yeah, if it made the assessment process—like if you could diagnose something, it might make the assessment process go faster, which might mean we could get the treatment sooner (Participant #044, Registered Nurse).

Again we would now have some validity, some agreement. Everybody looking at the picture hopefully would see the same thing and would know the implications and treatment would be more streamlined and specific […] a computer that would sort of use the data and have an ability to match that data and the diagnosis with available treatment. So there would be a greater validity to that as well, more evidence based treatment (Participant #103, Psychiatrist).

[…] it will also help more specific treatments to be found and explored and discovered for certain illnesses that have some neuroimaging-related findings. So it can have not only diagnostic classification but also developing specific treatment for conditions (Participant #107, Psychiatrist).

So, if I had a brain imaging scan where I could have someone come back in after they’re on medicine, check the brain scan and see how much of that seems to have been corrected in terms of the biology, then I have a better sense that yes, we’ve got the right kind of medicine, it’s doing what it should be doing biologically, and yet we’re still having difficulties (Participant #116, Psychiatrist).

Overall I think it’s a positive move, but again it needs to be correlated with the clinical situation, discussed with the patient in an appropriate way and against one of the many tools that we use to evaluate patients. So the larger clinical context, it needs to be put into that context. If it’s not, I think it could be misused—or people could come to the wrong conclusion on what a certain set of data may mean that’s revealed from the image (Participant #134, Psychiatrist).

People may then use that information to try to absolve themselves of some responsibility for their actions and say, “Well, you know, I can’t help it. It’s just the way my brain is wired” (Participant #133, Psychiatrist).

I guess I would be more concerned about what’s done with that information afterwards as long as there’s education and support for the family or the individual, even though there are say genetic factors that are put into place (Participant #036, Psychiatrist).

[…] someone who is labeled as potentially developing a certain mental illness. There might be employment opportunities, schooling opportunities that would be closed to you if people knew that you were at risk for those conditions (Participant #103, Psychiatrist).

There is a lot of concern about any kind of prediction of a mental health or a physical health problem that could impact a person’s eligibility for insurance coverage and medical care (Participant #109, Psychiatrist).

And here you have we’re again labeling someone as inevitably developing a condition that would perhaps interfere with their job perspective, or relationships. So [brain imaging] would open up, that person for further risk, other sorts of difficulties. It’s like any screening tool, now that you know you have it what can you do about it? (Participant #103, Psychiatrist).

Are people, are employers in the future going to be able to access some kind of [genetic testing] database that says, “You’ve got the depression gene, I don’t want to hire you because you might get depressed in 5 years and miss work.” I mean there’s all these room for abuses later on (Participant #128, Counselor).

For some families, knowing that means they are going to change the way they feel about that child. They’re going to change their expectations, in a negative way, and perhaps distance themselves. Or more or less reject the child (Participant #127, Psychiatrist).

I would hate for a parent to either lose hope in their child, you know, because they’re thinking, “Oh, this is where we’re going to end up anyway. So, what’s the point of doing any of these interventions right now, or getting the help that my child needs?” (Participant #036, Registered Nurse).

[Brain imaging] is also very limiting and may impact client’s motivation levels. And kind of may set them up for a doomed kind of scenario as opposed to a resilient hopeful scenario (Participant #023, Counselor).

I think no matter what the news is about genetic testing, it would definitely impact an individual’s perception of themselves and their, their behavior, their environment, their development; their life, really (Participant #058, Registered Nurse).

So you’d worry about suicide, you’d worry about people falling short of their expectations, not pushing themselves (Participant #125, Psychiatrist).

There may be the sense of, “Hey, this is the way the brain is, and nothing can change.” There can be a sense of feeling defeated or feeling that their opportunities in the future are limited (Participant #133, Psychiatrist).