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Diagosing Disorders

Diagosing Disorders - COPYRIGHT 2003 SCIENTIFIC AMERICAN...

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COPYRIGHT 2003 SCIENTIFIC AMERICAN, INC.
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ACCURATE DIAGNOSIS IS THE CORNERSTONE OF medical care. To plan a successful treatment for a patient, a doctor must first determine the nature of the illness. In most branches of medicine, physi- cians can base their diagnoses on objective tests: a doctor can examine x-rays to see if a bone is bro- ken, for example, or extract tissue samples to search for cancer cells. But for some common and serious psychiatric disorders, diagnoses are still based entirely on the patient’s own report of symptoms and the doctor’s observations of the pa- tient’s behavior. The human brain is so enor- mously complex that medical researchers have not yet been able to devise definitive tests to diagnose illnesses such as schizophrenia, autism, bipolar disorder or major depression. Because psychiatrists must employ subjective evaluations, they face the challenge of reliability: how to ensure that two different doctors arrive at the same diagnosis for the same patient. To address this concern, the American Psychiatric Association in 1980 published the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (wide- ly known by the acronym “DSM-III”). Unlike ear- lier editions of the manual, DSM-III and its suc- cessor volumes (the latest one is referred to as DSM-IV-TR) describe what symptoms must be present and for how long to make a diagnosis of a particular brain disorder. Virtually all these criteria, however, are based on the patient’s histo- ry and the clinical encounter. Without the ability to apply objective tests, physicians may fail to de- tect disorders and sometimes mistake the symp- toms of one illness for another’s. Making the task more difficult is the fact that some psychiatric ill- nesses, such as schizophrenia, may turn out to be clusters of diseases that have similar symptoms but require different treatments. In recent years, though, advances in genetics, brain imaging and basic neuroscience have promised to change the way that brain disorders are diagnosed. By correlating variations in DNA with disease risks, researchers may someday be able to determine which small differences in a pa- tient’s genetic sequence can make that person more vulnerable to schizophrenia, autism or oth- er illnesses. And rapid developments in neu- roimaging the noninvasive observation of a liv- www.sciam.com SCIENTIFIC AMERICAN 97 Brain disorders usually have behavioral symptoms that can be observed by a psychiatrist. But the checklist approach to diagnosis is far from perfect. DIAGNOSING DISORDERS PSYCHIATRIC ILLNESSES ARE OFTEN HARD TO RECOGNIZE, BUT GENETIC TESTING AND NEUROIMAGING COULD SOMEDAY BE USED TO IMPROVE DETECTION BY STEVEN E. HYMAN MELISSA SZALKOWSKI COPYRIGHT 2003 SCIENTIFIC AMERICAN, INC.
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ing brain may eventually enable doctors to spot structural features or patterns of brain activity that are characteristic of certain disorders. Better diag- nosis will lead to better care: after pinpointing a pa-
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