{
  "abstract": "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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, USA",
    "Department of Psychiatry & Center for Bioethics, Harvard Medical School, Boston, MA, USA",
    "Department of Psychiatry, University of Oxford, Oxford, UK",
    "National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre, University of Oxford, Oxford, UK",
    "Department of Neurology, University of Oxford, Oxford, UK",
    "Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany",
    "Uehiro Oxford Institute, University of Oxford, Oxford, UK",
    "Faculty of Philosophy, University of Oxford, Oxford, UK",
    "Department of Psychiatry, University of Cambridge, Cambridge, UK",
    "Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 11,
  "authors": [
    {
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        0,
        1
      ],
      "name": "Matthew L. Baum",
      "orcid": "0000-0001-6840-8932"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Graham Blackman",
      "orcid": "0000-0001-7025-8670"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Adam Al-Diwani",
      "orcid": "0000-0001-6596-7579"
    },
    {
      "affs": [
        2,
        3,
        4
      ],
      "name": "Adam Handel"
    },
    {
      "affs": [
        5
      ],
      "name": "Dominique Endres",
      "orcid": "0000-0001-7322-1195"
    },
    {
      "affs": [
        4
      ],
      "name": "Sophie Binks",
      "orcid": "0000-0003-0991-5998"
    },
    {
      "affs": [
        6,
        7
      ],
      "name": "Jonathan Pugh"
    },
    {
      "affs": [
        8
      ],
      "name": "John Ward",
      "orcid": "0000-0002-9108-7900"
    },
    {
      "affs": [
        6,
        9
      ],
      "name": "Julian Savulescu",
      "orcid": "0000-0003-1691-6403"
    },
    {
      "affs": [
        2
      ],
      "name": "Ilina Singh"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Belinda Lennox"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6aeps7v1jxkq4.bib",
  "cited_by": 3,
  "doi": "10.1192/bjp.2026.10675",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7619677/?tool=EBI",
  "id": "6aeps7v1jxkq4",
  "issns": [
    "0007-1250",
    "1472-1465"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC7619677",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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      "heading",
      "Article"
    ],
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      "openalex",
      "2805|Neuroethics, Human Enhancement, Biomedical Innovations"
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  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7619677/pdf/?tool=EBI",
  "pmcid": "PMC7619677",
  "pmid": "42299629",
  "published": "2026-06-16",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/6aeps7v1jxkq4.ris",
  "sources": [
    {
      "first_seen": "2026-11-03T15:20:51Z",
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  "subjects": [
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      "field": "biology",
      "origin": "openalex:2805|Neuroethics, Human Enhancement, Biomedical Innovations",
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  ],
  "title": "Ethical issues in the clinical use of diagnostic technologies for rare causes of psychosis",
  "title_text": "Ethical issues in the clinical use of diagnostic technologies for rare causes of psychosis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-06T12:20:42Z",
  "url": "https://research.draconitic.com/paper/6aeps7v1jxkq4",
  "venue": "The British journal of psychiatry : the journal of mental science",
  "versions": []
}