The pictured requisition form is a foundational document in Tunneling Molecular Psychiatry, which is a new clinical operating system.
This document forces us to consider a wide differential diagnosis in psychiatry. If we ever make only a “psychiatric differential diagnosis,” that alone is premature closure because it excludes all the possible medical causes/mimics/contributors/exacerbators of psychiatric signs and symptoms. As major psychiatry textbooks and guidelines state (including the DSM), medical conditions MUST be ruled out to grant any psychiatric diagnosis – even “simpler” diagnoses like ADHD, MDD, and GAD.
What is part of the architecture of the requisition form? There are internal checks & balances. For example, my minimum methylation screen is: B12, B6, folate, homocysteine, choline and urine MMA. Creatinine and cystatin C combined will give us the best estimated GFR. Most vitamins are best measured in whole blood/RBCs because serum/plasma levels are quite fleeting and do not reflect long-term stores. Organ system functions are investigated widely: adrenal, cardiac, hepatic, renal, thyroid, hematologic, etc. They all greatly influence brain and bodily health, including psychiatric signs and symptoms.
All studies are measured in their optimal compartments (e.g. whole blood, plasma, serum, urine, etc.) – barring CSF and other specimens collected from invasive procedures (e.g. tissue biopsy). The requisition form is designed to be maximally outpatient compatible, and invasive procedures would require different care settings.
There are parenthetical instructions for many studies based on published scientific and medical literature and our experience of obtaining those studies in the real world. For many tests, for example, fasting improves signal-to-noise ratio – which is already improved by selecting the right fluid compartment to test (see above).
My valued colleagues at Intermediate Unit 1 and Devereux TCV have already observed the power and efficacy of Tunneling Molecular Psychiatry (TMP). Every single (week)day, we have been capturing several nutrient deficiencies (e.g. B12, folate [B9], iron, copper, magnesium, calcium, ascorbate, vitamin D, thiamine [B1], pre-albumin, omega-3). In March 2026 alone, we also captured multiple cases of hepatitis C, other liver & biliary diseases, hypothyroidism, syphilis, Lyme disease, chronic kidney disease, anemias, celiac disease, heavy metal exposures, diabetes, hyperlipidemia, and much more.
I see 80-100 patients weekly, from toddlerhood up to centenarians, so my personal sample size is decent. In my experience, when all of the above conditions are treated, patients are often able to decrease or even discontinue psychotropic medication.
