Ethical issues in the clinical use of diagnostic technologies for rare causes of psychosis

Journal article

An estimated 5% of cases of first episode psychosis are due to rare and sometimes reversible causes that can be identified though diagnostic investigations that are currently less common in psychiatry, such as lumbar puncture, specialized brain imaging, or genetic testing. The current clinical practice of the use of such technologies, however, raises several challenging ethical questions. Drawing on our multi-disciplinary perspective spanning psychiatry, neurology, philosophy, neuroscience, sociology, and medical ethics from three countries we identify emerging ethical issues in the diagnosis of rare causes of psychosis. We group challenges in three main categories 1) diagnostic justice, 2) moral responsibility, and 3) unintended consequences of diagnostic workup. Justice challenges surrounded role of a) “luck”, b) social capital, and c) prior psychiatric diagnoses in determining access to workup. Moral responsibility challenges surround the extent to which a) clinicians should be expected to know the red flags and workup for rare or ultra-rare causes, b) those who run health systems should enable knowledgeable clinicians to provide the requisite workup. Challenges related to unintended consequences include the risk of pursuing workup of rare causes to reinforce a) psychiatric exceptionalism, b) paternalistic decision making that does not allow space for patient preferences. Finally, we reflect on unresolved issues and future directions.

Authors: Baum, ML; Blackman, G; Al-Diwani, A; Handel, A; Endres, D

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Cambridge University Press
• Journal: British Journal of Psychiatry
• Publication date: 2026-06-16
• Acceptance date: 2026-03-09
• DOI: 10.1192/bjp.2026.10675
• EISSN: 1472-1465
• ISSN: 0007-1250
• Language: English
• Keywords: diagnostic medicine; ethics; neuroimmunology; neuropsychiatry; precision medicine