Education on Genetics for Psychiatric Residents

Abstract

Two papers by Hoop et al. (1) and Winner et al. (2) in this issue of Academic Psychiatry call attention to the increasingly important need for psychiatric residents to receive a thorough grounding in the role of genetics and genomics in psychiatry as it will be practiced in the future. Taken together, the papers suggest that the topic of genetics is currently slighted in the curricula of many U.S. psychiatric residency training programs. An understanding of genetics will be critical to future psychiatrists not only for a fuller understanding of the etiology of disease entities, but also for an appreciation of the cause and treatment of psychiatric symptoms. Brain imaging techniques and genetics together are already providing correlative data to shed light on variability of presentation of some illnesses. For example, apolipoprotein E epsilon4 carriers with Alzheimer’s disease have been shown to have greater atrophy in the parietal cortex bilaterally and in the right hippocampus than noncarriers with Alzheimer’s disease (3). Surprising developmental discoveries involving the genetics of neurodegeneration are also being made. As an example, children and adolescents carrying the epsilon4 allele of the apolipoprotein E gene have been found to have, on average, thinner entorhinal cortices as demonstrated by MRI than do those carrying other alleles (4). Differences in the tendency to pay more attention to positive or negative elements in the environment have been shown to have a genetic basis. Individuals homozygous for the long allele for the promoter region of the serotonin transporter gene (5-HTTLPR) were recently found to show a marked bias to selectively pay attention to affectively positive material and to selectively avoid affectively negative material in their environment relative to those carrying at least one of the long alleles for the promoter region, meaning the homozygous long-allele carriers seem more likely to “look on the bright side,” which may explain their lower susceptibility to mood disorders than short-allele carriers (5). Research is ongoing on the interaction between trauma and genetic vulnerability to trauma. Variability in the promoter region of the serotonin transporter gene may be associated with the degree of emotional resilience shown by different individuals exposed to trauma (6). Integrating the most up-to-date scientific information into psychiatry training has been a priority since residencies in psychiatry were introduced. Genetics has been cited as a topic of critical importance in the curriculum of psychiatric residencies in several papers published over the past 15 years (7–9); the publication of two papers on the topic in this issue highlights the recognition of the need for the presence and standardization of a strong didactic curriculum in genetics in residencies. The Psychiatry Program Requirements of the Accreditation Council for Graduate Medical Education (10) currently state, “The didactic curriculum must include the following components: . . . the biological, genetic, psychological, sociocultural, economic, ethnic, gender, religious/spiritual, sexual orientation, and family factors that significantly influence physical and psychological development throughout the life cycle” (emphasis added). We believe that the professional associations of individuals involved in psychiatric residency education, including the American Association of Directors of Psychiatric Residency Training (AADPRT) and the Association for Academic Psychiatry (AAP) can play a useful role in helping to develop standard curricula in genetics by incorporating educational materials such as suggested readings, videos, and audiovisual presentations that training programs of all sizes could use to teach the fundamentals of psychiatric genetics to their residents. The two articles published in this issue of Academic Psychiatry together describe the opportunity that currently confronts residency training programs: to successfully educate psychiatrists about the rapidly expanding field of psychiatric Received and accepted November 6, 2009. The authors are affiliated with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee, Wisconsin. Address correspondence to Joseph B. Layde, M.D., J.D., Medical College of Wisconsin, Department of Psychiatry and Behavioral Medicine, 8701 Watertown Plank Rd., Milwaukee, WI 53226; jlayde@mcw.edu (e-mail). Copyright © 2010 Academic Psychiatry