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Sex Chromosome Rearrangement Associated With Hormonal Abnormalities and Gender Dysphoria. J Psychiatr Pract 2023; 29:71-76. [PMID: 36649555 DOI: 10.1097/pra.0000000000000679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Although disorders arising from sex chromosome and sex steroid abnormalities are well characterized from the perspectives of endocrinology, dysmorphology, and reproductive health, relatively little is known about neuropsychiatric development, gender identity, incongruence, and dysphoria in the populations with these disorders. In this report, we describe the case of a 21-year-old gender nonbinary individual identified as male at birth who presented to an academic psychiatry consultation clinic because of life-long gender dysphoria. The patient was found to have a complex sex chromosomal rearrangement and associated hormonal abnormalities that may, at least in part, explain the patient's history. In addition to describing a novel genetic change, this case and the accompanying review of the existing literature highlight the need for an increased focus on the psychiatric perspective, and sex and gender issues in particular, among all patients with sex chromosome abnormalities and inborn errors of steroid metabolism.
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2
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Álvaro-Sánchez S, Abreu-Rodríguez I, Abulí A, Serra-Juhe C, Garrido-Navas MDC. Current Status of Genetic Counselling for Rare Diseases in Spain. Diagnostics (Basel) 2021; 11:2320. [PMID: 34943558 PMCID: PMC8700506 DOI: 10.3390/diagnostics11122320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 12/29/2022] Open
Abstract
Genetic Counselling is essential for providing personalised information and support to patients with Rare Diseases (RD). Unlike most other developed countries, Spain does not recognize geneticists or genetic counsellors as healthcare professionals Thus, patients with RD face not only challenges associated with their own disease but also deal with lack of knowledge, uncertainty, and other psychosocial issues arising as a consequence of diagnostic delay. In this review, we highlight the importance of genetic counsellors in the field of RD as well as evaluate the current situation in which rare disease patients receive genetic services in Spain. We describe the main units and strategies at the national level assisting patients with RD and we conclude with a series of future perspectives and unmet needs that Spain should overcome to improve the management of patients with RD.
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Affiliation(s)
| | - Irene Abreu-Rodríguez
- Genetics Service, Hospital del Mar Research Institute, IMIM, 08003 Barcelona, Spain;
| | - Anna Abulí
- Department of Clinical and Molecular Genetics, Hospital Vall d’Hebron, 08035 Barcelona, Spain;
- Medicine Genetics Group, Vall d’Hebron Research Institute (VHIR), 08035 Barcelona, Spain
| | - Clara Serra-Juhe
- U705 CIBERER, Genetics Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain;
- Centro de Investigación Biomédica en Red en Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Maria del Carmen Garrido-Navas
- CONGEN, Genetic Counselling Services, C/Albahaca 4, 18006 Granada, Spain;
- Genetics Department, Faculty of Sciences, Universidad de Granada, 18071 Granada, Spain
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3
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When the Path to Parenthood Does Not Go as Planned: Genetic Counseling for Infertility and Miscarriage. CURRENT GENETIC MEDICINE REPORTS 2020. [DOI: 10.1007/s40142-020-00189-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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4
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McEwen A, Jacobs C. Who we are, what we do, and how we add value: The role of the genetic counseling 'philosophy of practice' statement in a changing time. J Genet Couns 2020; 30:114-120. [PMID: 32578374 DOI: 10.1002/jgc4.1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As genetics and genomics are integrated into health care and non-genetic health professionals deliver aspects of genetic counseling, it is increasingly important for genetic counselors to be able to define who we are, what we do, and how we add value to client interactions, both on an individual and professional basis. In this paper, we argue that to understand ourselves as individual practitioners and as a profession, we each need to reflect on, write, and constantly review our own philosophy of practice. A philosophy of practice is a dynamic, personal, and reflective statement or narrative that captures the core ideas, values, and beliefs of the individual about their chosen profession, including concrete examples of what this involves in practice. Here, we consider the nature, purpose, and relevance of a philosophy of genetic counseling practice, drawing on examples from professions such as teaching and nursing, where the exercise of writing a philosophy of practice is more established. We demonstrate how and why we have introduced writing a philosophy of practice into our Master of Genetic Counseling program at University of Technology Sydney and consider the possibilities for introducing such practice into professional registration or certification processes. Finally, we offer our own philosophy of genetic counseling practice as an example. As the roles and scope of practice for genetic counselors expand and diversify, it is increasingly important to understand, own, and retain our core values and principles as individual practitioners and as a profession. Ensuring client-centered practice remains at the heart of genetic health care is vital. We encourage all genetic counselors to write, publish, and share their philosophy of practice, adding to our collective professional identity in this time of change and opportunity.
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Affiliation(s)
- Alison McEwen
- Genetic Counseling, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Chris Jacobs
- Genetic Counseling, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
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5
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Cordner ZA, MacKinnon DF, DePaulo JR. The Care of Patients With Complex Mood Disorders. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:129-138. [PMID: 33162850 PMCID: PMC7587882 DOI: 10.1176/appi.focus.20200007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article focuses on some common dilemmas facing clinicians, patients, and families in managing the treatment of complicated mood disorders. Specifically, this article reviews the interaction of depressive states, including unipolar, bipolar, and mixed, with other adversities, including comorbid physical and psychological disorders, personality vulnerabilities, misuse of drugs and alcohol, and social and family problems. These issues are not always clearly differentiated from the depressive illness. Each of these adversities can worsen an existing mood disorder and influence the patient's resolve to persist with a treatment plan. Although this article is not focused strictly on treatment-resistant depression, these coexisting issues make depressive states harder to manage therapeutically. For brevity, the aim of this article has been limited to discussion of some complex situations that psychiatrists in general practice may encounter.
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Affiliation(s)
- Zachary A Cordner
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cordner, MacKinnon, DePaulo)
| | - Dean F MacKinnon
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cordner, MacKinnon, DePaulo)
| | - J Raymond DePaulo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore (Cordner, MacKinnon, DePaulo)
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6
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Elliott AM. Genetic Counseling and Genome Sequencing in Pediatric Rare Disease. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036632. [PMID: 31501267 DOI: 10.1101/cshperspect.a036632] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Both genome sequencing (GS) and exome sequencing (ES) have proven to be revolutionary in the diagnosis of pediatric rare disease. The diagnostic potential and increasing affordability make GS and ES more accessible as a routine clinical test in some centers. Herein, I review aspects of rare disease in pediatrics associated with the use of genomic technologies with an emphasis on the benefits and limitations of both ES and GS, complexities of variant classification, and the importance of genetic counseling. Indications for testing, the role of genetic counselors in genomic test selection, and the diagnostic potential of ES and GS in various pediatric multisystem disorders are discussed. The neonatal population represents an important cohort in pediatric rare disease. Rapid ES and GS in critically ill neonates can have an immediate impact on medical management and present unique genetic counseling challenges. This work includes reviews of recommendations for genetic counseling for families considering genome-wide sequencing, and issues of access to genetic counseling that affect clinical use and will necessitate implementation of innovative methods such as online decision aids. Finally, this work will also review the challenges of having a child with a rare disease, the impact of results from ES and GS on these families, and the role of various support agencies.
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Affiliation(s)
- Alison M Elliott
- Department of Medical Genetics, University of British Columbia Investigator, BC Children's Hospital Research Institute and BC Women's Health Research Institute, and Provincial Medical Genetics Program, Vancouver, British Columbia V6H 3N1, Canada
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7
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Encina G, Castillo-Laborde C, Lecaros JA, Dubois-Camacho K, Calderón JF, Aguilera X, Klein AD, Repetto GM. Rare diseases in Chile: challenges and recommendations in universal health coverage context. Orphanet J Rare Dis 2019; 14:289. [PMID: 31931841 PMCID: PMC6958742 DOI: 10.1186/s13023-019-1261-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/22/2019] [Indexed: 12/26/2022] Open
Abstract
Rare diseases (RDs) are a large number of diverse conditions with low individual prevalence, but collectively may affect up to 3.5-5.9% of the population. They have psychosocial and economic impact on patients and societies, and are a significant problem for healthcare systems, especially for countries with limited resources. In Chile, financial protection exists for 20 known RDs through different programs that cover diagnosis and treatments. Although beneficial for a number of conditions, most RD patients are left without a proper legal structure that guarantees a financial coverage, and in a vulnerable situation. In this review, we present and analyze the main challenges of the Chilean healthcare system and legislation on RDs, and other ambits of the RD ecosystem, including patient advocacy groups and research. Finally, we propose a set of policy recommendations that includes creating a patient registry, eliciting social preferences on health and financial coverage, improving access to clinical genetic services and therapies, promoting research on RDs and establishing a Latin-American cooperation network, all aimed at promoting equitable quality healthcare access for people living with RDs.
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Affiliation(s)
- Gonzalo Encina
- Centro de Genética y Genómica, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Juan A Lecaros
- Observatorio de Bioética y Derecho, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Karen Dubois-Camacho
- Federación Chilena de Enfermedades Raras, Santiago, Chile
- Laboratorio de Inmunidad Innata, Programa de Inmunología, Facultad de Medicina, Instituto de Ciencias Biomédicas, Universidad de Chile, Santiago, Chile
| | - Juan F Calderón
- Centro de Genética y Genómica, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Ximena Aguilera
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Andrés D Klein
- Centro de Genética y Genómica, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Gabriela M Repetto
- Centro de Genética y Genómica, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
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How Can Stoic Philosophy Inspire Psychosocial Genetic Counseling Practice? An Introduction and Exploration. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2019. [DOI: 10.1007/s10942-019-00330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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9
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New developmental syndromes: Understanding the family experience. J Genet Couns 2019; 28:202-212. [DOI: 10.1002/jgc4.1121] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 01/18/2023]
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10
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Macnamara EF, Schoch K, Glanton E, Fieg E, Brokamp E, Signer R, LeBlanc K, McConkie-Rosell A, Palmer CGS. Cases from the Undiagnosed Diseases Network: The continued value of counseling skills in a new genomic era. J Genet Couns 2019; 28:194-201. [PMID: 30680851 PMCID: PMC6456366 DOI: 10.1002/jgc4.1091] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/14/2018] [Accepted: 12/16/2018] [Indexed: 01/15/2023]
Abstract
The "diagnostic odyssey" is well known and described in genetic counseling literature. Studies addressing the psychological, emotional, and financial costs of not having a diagnosis have shown how it permeates the lives of patients and families. The Undiagnosed Diseases Network aims to end this odyssey by providing diagnoses to individuals with undiagnosed conditions through multidisciplinary evaluations, whole exome and genome sequencing, and basic science research. It also provides an opportunity to learn from patients and families and to better understand their journeys and the impact of receiving a diagnosis. Seven cases are presented that outline challenges that come from working with chronically undiagnosed and newly diagnosed patients in a time when sequencing for clinical diagnosis is rapidly increasing. They illuminate the emotional journey of patients and families searching for a diagnosis and the mental health problems, financial distress, and chaos that can accompany not having answers. They also illustrate the surprising reactions patients and families can have to receiving a diagnosis, including anger, grief, and disappointment. While the lessons learned from these families are not novel, new strategies are presented for handling these challenges in undiagnosed and ultra-rare populations, groups that will increase with the rise of clinical sequencing.
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Affiliation(s)
- Ellen F Macnamara
- National Institutes of Health, Undiagnosed Diseases Program, Common Fund, Office of the Director, NIH, Bethesda, Maryland
| | - Kelly Schoch
- Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina
| | - Emily Glanton
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth Fieg
- Division of Genetics, Brigham and Women's Hospital, Boston, Massachusetts
| | - Elly Brokamp
- Division of Genetics and Genomic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebecca Signer
- Department of Human Genetics, University of California, Los Angeles, California
| | - Kimberly LeBlanc
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Allyn McConkie-Rosell
- Division of Medical Genetics, Duke University Medical Center, Durham, North Carolina
| | - Christina G S Palmer
- Department of Human Genetics, University of California, Los Angeles, California
- Department of Psychiatry & Biobehavioral Sciences, University of California, Los Angeles, California
- Institute for Society and Genetics, University of California, Los Angeles, California
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11
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Ayres S, Gallacher L, Stark Z, Brett GR. Genetic counseling in pediatric acute care: Reflections on ultra-rapid genomic diagnoses in neonates. J Genet Couns 2019; 28:273-282. [DOI: 10.1002/jgc4.1086] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/11/2018] [Accepted: 12/02/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Samantha Ayres
- Australian Genomics Health Alliance; Melbourne Australia
- Melbourne Genomics Health Alliance; Melbourne Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute; Melbourne Australia
| | - Lyndon Gallacher
- Australian Genomics Health Alliance; Melbourne Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
| | - Zornitza Stark
- Australian Genomics Health Alliance; Melbourne Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
| | - Gemma R. Brett
- Australian Genomics Health Alliance; Melbourne Australia
- Melbourne Genomics Health Alliance; Melbourne Australia
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute; Melbourne Australia
- Department of Paediatrics; University of Melbourne; Melbourne Australia
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12
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Duc JK, Herbert AR, Heussler HS. Paediatric palliative care and intellectual disability—A unique context. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2017; 30:1111-1124. [DOI: 10.1111/jar.12389] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 01/21/2023]
Affiliation(s)
- Jacqueline K Duc
- Paediatric Palliative Care ServiceChildren's Health Queensland Australia
- Centre for Children's Health Ethics and LawQueensland Health Australia
- Faculty of MedicineUniversity of Queensland Brisbane Australia
| | - Anthony Robert Herbert
- Paediatric Palliative Care ServiceChildren's Health Queensland Australia
- Centre for Children's Health Ethics and LawQueensland Health Australia
- Faculty of MedicineUniversity of Queensland Brisbane Australia
| | - Helen S Heussler
- Paediatric Palliative Care ServiceChildren's Health Queensland Australia
- Faculty of MedicineUniversity of Queensland Brisbane Australia
- Mater Research InstituteUniversity of Queensland Brisbane Australia
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Nariman A, Sobhan MR, Savaei M, Aref-Eshghi E, Nourinejad R, Manoochehri M, Ghahremani S, Daliri F, Daliri K. The genetic background of Southern Iranian couples before marriage. Balkan J Med Genet 2016; 19:71-74. [PMID: 28289591 PMCID: PMC5343333 DOI: 10.1515/bjmg-2016-0038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Genetic service for couples plays an increasingly important role in diagnosis and risk management. This study investigated the status of consanguinity and the medical genetic history (effectiveness and coverage of medical genetic services) in couples residing in a city in southern Iran. We questioned couples who were referred to Behbahan Marital Counseling Center, Behbahan, Iran, during the period from January to November 2014, to obtain information on consanguinity, disease history, and previous referral to a medical genetics center. For the collected data was obtained descriptive statistics with STATA 11.0 software. A total of 500 couples were questioned. Mean age was 24.8 ± 5.2 years. Almost one quarter (23.4%) of the couples were consanguineous. Consanguinity was almost twice as common in rural areas as in urban areas (33.9 vs. 19.2%, p = 0.001). Only a few couples (~3.0%) had ever been referred for genetic counseling. The main reason for previous genetic counseling was consanguinity (85.7%). The majority of the participants (96.3%) had never been tested for any genetic conditions. Our findings suggest that only a small proportion of couples in Khuzestan Province, Iran (Behbahan City) were receiving adequate genetics care. This may reflect the limited accessibility of such services, and inadequate awareness and education among the care providers.
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Affiliation(s)
- A Nariman
- Department of Human Genetics, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - MR Sobhan
- Department of Orthopedics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - M Savaei
- Department of Anesthesiology, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - E Aref-Eshghi
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - R Nourinejad
- Department of Human Genetics, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - M Manoochehri
- School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - S Ghahremani
- Department of Clinical Psychology, Iran University of Medical Sciences, Tehran, Iran
| | - F Daliri
- Department of Psychology, Islamic Azad University, Marvdasht Branch, Marvdasht, Iran
| | - K Daliri
- Department of Human Genetics, Behbahan Faculty of Medical Sciences, Behbahan, Iran
- Dr. Karim Daliri, Department of Human Genetics, Behbahan Faculty of Medical Sciences, Bashir Boulevard, Behbahan, Iran. Tel: +98-9374140937. Fax: +98-9374140937
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Abad PJB, Anonuevo CA, Daack-Hirsch S, Abad LR, Padilla CD, Laurino MY. Communication about Congenital Adrenal Hyperplasia: Perspective of Filipino Families. J Genet Couns 2016; 26:763-775. [DOI: 10.1007/s10897-016-0043-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 10/26/2016] [Indexed: 01/08/2023]
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15
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Experiences of Being Heterozygous for Fabry Disease: a Qualitative Study. J Genet Couns 2016; 25:1085-92. [PMID: 26948256 DOI: 10.1007/s10897-016-9941-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/18/2016] [Indexed: 12/18/2022]
Abstract
Little is known about the experiences of women with Fabry disease. The aim of this study was to explore women's experiences of being heterozygous for Fabry disease. We used an explorative qualitative study design and selected ten Norwegian women who were known heterozygous for Fabry disease to participate. We conducted in-depth semi-structured interviews and analyzed the interviews using inductive thematic analysis. We found that learning about one's heterozygous status may be devastating for some. However, for most of the participants, heterozygous status, as well as doctors' acceptance of symptoms in women heterozygous for Fabry disease, provided an explanation and relief. Although many women did not consider themselves ill, they wished to be acknowledged as more than "just carriers." The participants were grateful for enzyme replacement therapy, although it had its burdens regarding time, planning, and absences from school or work. Women with Fabry disease felt that the lack of knowledge among healthcare professionals about Fabry disease was frustrating and worrisome. These findings suggest that healthcare professionals should acknowledge the different ways women react to their diagnosis, and be aware of the personal costs of receiving treatment.
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