Genetic Counseling For Psychiatric Disorders Research Articles

Evidence-Based Genetic Counseling for Psychiatric Disorders: A Road Map.

Psychiatric disorders, such as schizophrenia, depression, anxiety, and bipolar disorder, are common conditions that arise as a result of complex and heterogeneous combinations of genetic and environmental factors. In contrast to childhood neurodevelopmental conditions such as autism and intellectual disability, there are no clinical practice guidelines for applying genetic testing in the context of these conditions. But genetic counseling and genetic testing are not synonymous, and people who live with psychiatric disorders and their family members are often interested in what psychiatric genetic counseling can offer. Further, research shows that it can improve outcomes like empowerment for this population. Despite this, psychiatric genetic counseling is not yet routinely or widely offered. This review describes the state of the evidence about the process and outcomes of psychiatric genetic counseling, focusing on its clinical implications and remaining research gaps.

Genetic Counseling For Psychiatric Disorders: Establishing A Framework In The Genomic Era

Overall Abstract Following on from a Banbury meeting in the Fall of 2016: Genetic counseling for psychiatric disorders: challenges in the genomic era, this symposium will address how we establish a framework to support effective co-operation between psychiatrists, clinical geneticists and genetic counselors. We established that differences in semantics between clinical geneticists and researchers in psychiatric genetics focused around explanatory or diagnostic and predictive or susceptibility testing. The divergent ways in which genetic testing is applied to autism in comparison to other psychiatric disorders, through microarray and CNV testing, raises important considerations for examining the impact of CNV identification on patients and their care. In addition, there is an urgent need to educate psychiatric residents about genetic syndromes and we will discuss how future efforts will focus on integrating genetic discoveries into patient care. Similarly, pharmacogenetic testing on all psychiatric conditions is not warranted at this time; however, there are clear circumstances when it should be considered. Specifically, the elderly and youth may be more at risk and testing for variants that are known to increase risk for adverse outcomes should be encouraged. Finally, in complimenting current and future (pharmaco)genetic testing, psychiatric genetic counseling should be made available to all who request it. We will highlight the global effort for implementing this, discuss how best to bring clinical genetics and psychiatry closer together and consider ways to develop evidence based studies in psychiatric genetic counseling, to keep abreast with the fast pace of genetic discovery in mental illness.

The Efficacy of Genetic Counseling for Psychiatric Disorders: a Meta-Analysis.

Psychiatric illnesses are complex, highly heritable disorders that have substantial implications for both affected individuals and their families. Though genetic testing is currently limited in its clinical usefulness in this area, interest in genetic counseling for psychiatric disorders has a relatively long history and many positive outcomes have been posited. Yet, empirical studies of genetic counseling outcomes have been emerging only more recently. The aim of the current meta-analysis was to analyze the efficacy of genetic counseling and explore potential moderators of its effect. An extensive electronic search was conducted investigating the literature published until July 2016. The initial search resulted in 2367 articles, four of which met the inclusion criteria and were included in the quantitative meta-analysis. Effect size parameters and sample sizes for all variables in each study were included. The efficacy has ben demonstrated both at post-intervention and at follow up, with an overall statistically significant effect size of moderate intensity. Implications of this study are discussed in detail.

Prenatal genetic counselling for psychiatric disorders.

Psychiatric disorders like schizophrenia, bipolar disorder, depression, anxiety, and obsessive-compulsive disorder are common disorders with complex aetiology. They can exact a heavy toll on the individual with the condition and can have significant impact on family members too. Accordingly, psychiatric disorders can arise as a concern in the prenatal context - couples may be interested in learning about the chance for their child to develop the illness that manifests in the family and may be interested in discussing options for prenatal testing. However, the complex nature of these conditions can present challenges for clinicians who seek to help families with these issues. We established the world's first specialist genetic counselling service of its kind in Vancouver, Canada, in 2012, and to date, have provided counselling for ~500 families and have demonstrated increases in patients' empowerment and self efficacy after genetic counselling. We draw on our accumulated clinical experience to outline the process by which we approach prenatal genetic counselling for psychiatric disorders to assist other clinicians in providing thoughtful, comprehensive support to couples seeking out this service. © 2016 John Wiley & Sons, Ltd.

Erratum to: Genetic Counselling for Psychiatric Disorders: Accounts of Psychiatric Health Professionals in the United Kingdom.

Erratum to: Genetic Counselling for Psychiatric Disorders: Accounts of Psychiatric Health Professionals in the United Kingdom.

Genetic Counselling for Psychiatric Disorders: Accounts of Psychiatric Health Professionals in the United Kingdom.

Genetic counselling is not routinely offered for psychiatric disorders in the United Kingdom through NHS regional clinical genetics departments. However, recent genomic advances, confirming a genetic contribution to mental illness, are anticipated to increase demand for psychiatric genetic counselling. This is the first study of its kind to employ qualitative methods of research to explore accounts of psychiatric health professionals regarding the prospects for genetic counselling services within clinical psychiatry in the UK. Data were collected from 32 questionnaire participants, and 9 subsequent interviewees. Data analysis revealed that although participants had not encountered patients explicitly demanding psychiatric genetic counselling, psychiatric health professionals believe that such a service would be useful and desirable. Genomic advances may have significant implications for genetic counselling in clinical psychiatry even if these discoveries do not lead to genetic testing. Psychiatric health professionals describe clinical genetics as a skilled profession capable of combining complex risk communication with much needed psychosocial support. However, participants noted barriers to the implementation of psychiatric genetic counselling services including, but not limited to, the complexities of uncertainty in psychiatric diagnoses, patient engagement and ethical concerns regarding limited capacity.

Psychiatric Genetics: Applications in Clinical PracticeEdited by Jordan W. Smoller, M.D., Sc.D., Beth Rosen Sheidly, M.S., C.G.C., Ming T. Tsuang, M.D., Ph.D., D.Sc. American Psychiatric Publishing, Washington, D.C., 2008 323 pages ISBN 9781585622061 $65.00 Book Review Editor Paula T. Trzepacz, M.D.

Back to table of contents Previous article BOOK-REVIEWFull AccessPsychiatric Genetics: Applications in Clinical PracticeRichard Kennedy M.D., Ph.D.Richard Kennedy M.D., Ph.D.Search for more papers by this authorPublished Online:1 Jul 2010https://doi.org/10.1176/jnp.2010.22.3.353AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Modern genetic analyses have dramatically improved our understanding and treatment of many diseases. Although psychiatry has been relatively late in joining this revolution, psychiatric genetics is now a rapidly growing field with considerable promise. However, the growing research is often poorly understood and utilized by most clinicians. Psychiatric Genetics: Applications in Clinical Practice is intended to bridge this gap and make current research more accessible in daily practice. The book is divided into three parts: general principles, genetics of specific disorders, and special topics. The section on general principles begins with a primer on psychiatric genetics, with an emphasis on linkage and association studies. It also introduces terminology and, most importantly, describes the information that can be learned from each type of study and their limitations. Another chapter covers principles of genetic counseling, so the clinician may better understand and utilize the resources genetic counselors provide. The third chapter focuses on risk communication. Written to assist the clinician in communicating information more effectively with patients, many practitioners will also find it valuable for better understanding the meaning of risks described in the genetic literature.The second part covers the genetics of specific disorders, including childhood-onset disorders, psychotic disorders, mood and anxiety disorders, and Alzheimer’s disease. Each chapter describes the genetic epidemiology of the disorder, reviewing the evidence for heritability and familial transmission without mention of particular genes. Material on molecular genetics reviews the evidence implicating specific genes, focusing on the strongest candidates based on our current understanding of psychopharmacology. A chapter on neuropsychiatric aspects of genetic disorders describes the behavioral aspects of genetic disorders that are likely to be referred to a psychiatrist.The third part covers special topics that are likely to arise in the context of genetic counseling for psychiatric disorders. One chapter covers the teratogenicity of psychotropic medications. Another chapter covers ethical, legal, and social implications, especially the broader duties of the clinician to persons other than the patient. Finally, a chapter on future directions describes the applications of genetic testing in the clinical arena that are likely to be available in the near future. In a complex field such as psychiatric genetics, no single book is suitable for all audiences. Psychiatric Genetics is intended for the psychiatrist wishing to have a broad overview of the field to better interpret the clinical literature and be able to provide general advice for patients concerned about their genetic risk for mental illness. It is not suitable for those needing to understand the latest “cutting-edge” genetic technologies. Similarly, researchers needing detailed information on specific genetic contributions to psychiatric disorders or on methods of genetic analysis will find this volume inadequate. Within its stated scope and purpose, it succeeds admirably, distilling a vast amount of information into an easily readable volume emphasizing practical implications of genetics. Those within its proposed audience will find Psychiatric Genetics a valuable addition to their libraries. Dr. Kennedy is a Postdoctoral Fellow in Statistical Genetics at the University of Alabama at Birmingham. FiguresReferencesCited byDetailsCited byNone Volume 22Issue 3 Summer, 2010Pages 353-353 Metrics PDF download History Published online 1 July 2010 Published in print 1 July 2010

Exploring Genetic Counselors’ Perceptions of and Attitudes towards Schizophrenia

Schizophrenia is a common complex condition, for which no genetic testing is yet clinically available. Genetic counseling for psychiatric disorders is viewed by genetic counselors as a growth area, and to meet any increase in demand it is important to understand existing context. Thus, we surveyed general practice members of the National Society of Genetic Counselors, to examine perceptions and attitudes relating to schizophrenia. A total of 136 genetic counselors completed the survey, of whom 50% were engaged in general practice roles and therefore eligible to participate. Of these, 40% reported ‘rarely’ or ‘never’ asking about psychiatric illness when taking a family history. Some respondents expressed concern that discussing genetics of schizophrenia and providing risk assessment with families may be more confusing or worrisome than helpful. Many counselors reported that patients feel frustrated with the inability of genetic counselors to provide individual risk calculations. It appears that genetic counselors are reluctant to ask patients about psychiatric illness, and are concerned that their services might not be helpful in the context of schizophrenia.

The Genomic Era and Serious Mental Illness: A Potential Application for Psychiatric Genetic Counseling

Genetic counseling is an important clinical service that is routinely offered to families affected by genetic disorders or by complex disorders for which genetic testing is available. It is not yet routinely offered to individuals with serious mental illnesses and their families, but recent findings that beliefs about the cause of mental illness can affect an individual's adaptation to the illness suggest that genetic counseling may be a useful intervention for this population. In a genetic counseling session the counselor discusses genetic and environmental contributors to disease pathogenesis; helps individuals explore conceptions, fears, and adaptive strategies; and provides nondirective support for decision making. Expected outcomes may include reductions in fear, stigma, and guilt associated with a psychiatric diagnosis; improvements in adherence to prescribed medications; declines in risk behaviors; and reductions in misconceptions about the illness. The authors endorse a multidisciplinary approach in which a psychiatrist and genetic counselor collaborate to provide comprehensive psychiatric genetic counseling.

Le conseil génétique en psychiatrie

There are several lines of evidence supporting the role of genetic factors in major psychiatric disorders. The evidence is mainly provided by family and twin studies. These have documented the familiality of disorders such as autism, schizophrenia, bipolar disorder or major depression. These data are relevant in providing information about familial risk of illness. Nevertheless, the available information is still limited and this probably justifies the little attention paid to genetic counselling for psychiatric disorders. However, probably related to the recent high profile of genetics, clinicians are now confronted with questions from patients and their families regarding risks of disorders for themselves and/or their relatives. Despite the difficulty to precise the risk of recurrence for psychiatric disorders and since having a family history of the disorder is currently the best predictor for the development of these disorders, it is noteworthy that the American Psychiatric Association guidelines for the treatment of bipolar disorder suggest that genetic counselling is helpful for patients who are considering having children. In the coming years the expected identification of susceptibility genes for psychiatric disorders may bring new opportunities and expectations from patients and families for the clinical translation of research findings in psychiatric genetics. We review evidence for possible increasing demand for genetic counselling, particularly if specific genes related to psychiatric disorders are identified. We also explore both the potential role of genetic counselling for psychiatric disorders and the issues involved in conveying genetic information in the clinical setting. The psychiatry genetics is currently in its infancy, but with accelerating advances in understanding the genetic basis of psychiatric disorders, psychiatrists will certainly be called upon to incorporate genetic information into clinical practice.

Genetic counselling for psychiatric disorders

Family, adoption and twin studies demonstrate that many adult psychiatric disorders, including schizophrenia, major depression and bipolar disorder, have a clear genetic component. The aetiology of psychiatric disorders is a complex combination of both genetic and environmental components. While potential susceptibility genes for psychiatric disorders have been identified, interaction with the environment is a crucial component in disease development. Pharmacogenetics and genetic testing have the potential to play key roles in the future of clinical psychiatry. At present, an increased risk of psychiatric disorders can be identified through a detailed family history. The empirical risk of developing a disorder has been determined for many psychiatric disorders and can be used as a general guide. Genetic counselling can extend and enhance patient care by providing information to patients about the complexities of inheriting psychiatric disorders and the associated risks of recurrence. The genetic counselling process can facilitate informed decision making, alleviate misconceptions and reduce stigma through an improved understanding of the genetic cause of psychiatric disorders, and offer support to patients and their families.

Genetic Counseling in Psychiatry

While psychiatrists may commonly discuss family history in clinical practice, there has been little systematic research documenting the role and effectiveness of genetic counseling for psychiatric disorders. In the coming years, the expected identification of susceptibility genes for psychiatric disorders may bring new opportunities and expectations from patients and families for the clinical translation of research findings in psychiatric genetics. We review evidence for possible increasing demand for genetic counseling, particularly if specific genes related to psychiatric disorders are identified. We then explore both the potential role of genetic counseling for psychiatric disorders and the issues involved in conveying genetic information in the clinical setting. Further research regarding the effectiveness of counseling interventions, as well as additional efforts directed at genetics education for clinicians, will be needed if emerging advances in genetic research are to be incorporated into clinical practice.

Genetic counseling for psychiatric disorders.

Like other medical conditions, some psychiatric disorders are inherited, whereas others are not. Human genetics research is moving at a rapid pace. Genes for over 450 genetic disorders have been cloned and many disease-causing mutations have also been identified. The explosion of this new knowledge has created many new exciting opportunities in the diagnosis of these heritable disorders. The rapid pace of gene discovery will aid the identification of susceptibility genes for psychiatric disorders. Indeed, we can look forward to answers to many clinical and research questions. These are some of the gifts that the expanding field of human genetics research will continue to bring to medical science. However, as genetic tests for the detection of psychiatric disorders become available, many ethical, legal, and social implications will need to be considered. In this article, we review the principles of genetic counseling for psychiatric disorders, as well as the social and ethical dilemmas that genetic testing may bring. Although medical and scientific advances may bring many gifts, we should approach this new knowledge with caution, as one of the gifts may be a Pandora's box.