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Petzke TM, Rodriguez-Girondo M, van der Meer LB. The Hold me Tight Program for Couples Facing Huntington's Disease. J Huntingtons Dis 2022; 11:203-215. [PMID: 35466944 DOI: 10.3233/jhd-210516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A positive predictive genetic test for Huntington's disease (HD) can be a life-changing event for both carriers and their partners, leading to lower wellbeing and increasing the risk for separation and divorce. The 'Hold me Tight' program (HmT), based on emotionally focused couples' therapy, aims at strengthening the couple bond by targeting attachment needs. OBJECTIVE This study investigates whether the HmT program helps couples strengthen their relationship, as an investment in a future where the disease will affect life in many ways. METHODS In a multiple baseline design using three baselines of varying length, 15 couples of presymptomatic HD-carriers and their partners were included. In three consecutive groups, couples underwent the intervention (an adapted version of the 8-session HmT program) in four weekly sessions and completed self-report questionnaires throughout the study period of 19 weeks (17 measurements). Attachment style was assessed at baseline, resilience at baseline and at the end of the follow-up, while relationship satisfaction and wellbeing were measured weekly. A multi-level model was applied to the data. RESULTS Over the course of the study, wellbeing and relationship satisfaction significantly improved; resilience, however, did not. Furthermore, all three outcome measures were moderated by attachment style, with more securely attached individuals showing better outcomes. CONCLUSION HmT improved wellbeing and relationship satisfaction of couples facing HD. Due to these improvements and high patient acceptability rates, this program could become a standardized procedure in HD care. The program could be adapted for other populations, e.g., couples facing other genetic neurological disorders.
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Affiliation(s)
- Tara M Petzke
- Department of Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands.,Deptartment of Health, Medical, and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Mar Rodriguez-Girondo
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
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2
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Bannon SM, Grunberg VA, Manglani HR, Lester EG, Ritchie C, Vranceanu AM. Together from the start: A transdiagnostic framework for early dyadic interventions for neurodegenerative diseases. J Am Geriatr Soc 2022; 70:1850-1862. [PMID: 35435998 DOI: 10.1111/jgs.17801] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/27/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neurodegenerative diseases (NDDs) are increasingly prevalent and radically alter the lives of individuals and their informal care partners (together called a dyad). As symptoms progress, dyads are at risk for elevated emotional distress and declines in relationship functioning and quality of life. Psychosocial interventions delivered to dyads early after diagnosis have successfully prevented chronic emotional distress across several chronic illnesses including cancer and acute brain injury. Dyads with NDD could benefit from such interventions, however, they are limited. Because NDDs have symptom profiles that are distinct from other chronic illnesses, they require a unique framework and interventions. Given the limited dyadic interventions and unified symptoms across NDDs, a transdiagnostic framework may help to enhance scalability and efficiency. To address this problem, we developed a transdiagnostic framework that cuts across NDD physical and emotional diagnoses to inform cost-effective and sustainable NDD dyadic interventions. METHODS To develop this framework, we conducted: (1) a narrative review on dyadic adjustment and existent dyadic interventions for those with NDDs, and (2) integrated findings to develop our NDD transdiagnostic framework for dyadic interventions early after diagnosis. RESULTS Findings revealed no existent dyadic interventions for NDDs delivered shortly after diagnosis. Among available interventions, all were delivered later in disease progression, thereby focusing on dyadic challenges at more advanced stages. In addition, although research emphasized the influence of individual, dyadic, and contextual factors on dyads' early adjustment to NDDs, no conceptual model has been developed. Informed by theory and current research, we introduce an NDD transdiagnostic framework for couples' early biopsychosocial adjustment. This framework includes NDD specific: contextual factors, illness-related factors, individual and dyadic stressors, adaptive coping strategies, and dyads' resources. CONCLUSIONS Our NDD transdiagnostic framework can be used to inform early dyadic psychosocial interventions that cut across all NDDs. This approach has important implications for implementation and scalability.
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Affiliation(s)
- Sarah M Bannon
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Victoria A Grunberg
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Heena R Manglani
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ethan G Lester
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Ritchie
- Mongan Institute Center for Aging and Serious Illness and the Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Mongan Institute Center for Aging and Serious Illness and the Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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3
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Goldman JS. Predictive Genetic Counseling for Neurodegenerative Diseases: Past, Present, and Future. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036525. [PMID: 31548223 DOI: 10.1101/cshperspect.a036525] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Predictive genetic counseling for neurodegenerative diseases commenced with Huntington's disease (HD). Because the psychological issues and outcomes have been best studied in HD, the HD genetic counseling and testing protocol is still accepted as the gold standard for genetic counseling for these diseases. Yet, advances in genomic technology have produced an abundance of new information about the genetics of diseases such as Alzheimer's disease, frontotemporal dementia, amyotrophic lateral sclerosis, and Parkinson's disease. The resulting expansion of genetic tests together with the availability of direct-to-consumer testing and clinical trials for treatment of these diseases present new ethical and practical issues requiring modifications to the protocol for HD counseling and new demands on both physicians and genetic counselors. This work reviews the history of genetic counseling for neurodegenerative diseases, its current practice, and the future direction of genetic counseling for these conditions.
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Affiliation(s)
- Jill S Goldman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Vagelos College of Medicine, New York, New York 10032, USA
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4
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Improving follow up after predictive testing in Huntington's disease: evaluating a genetic counselling narrative group session. J Community Genet 2019; 11:47-58. [PMID: 31001731 PMCID: PMC6962407 DOI: 10.1007/s12687-019-00416-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/11/2019] [Indexed: 11/21/2022] Open
Abstract
Recently updated Huntington’s disease (HD) predictive testing guidelines emphasise clinicians’ responsibility to facilitate emotional support following testing, regardless of the result. Yet models of post-test counselling support are poorly defined. Moreover, it is unclear how these might be best delivered. In this project, a genetic counsellor and clinical psychologist developed standalone group sessions using collective narrative practices for individuals post-predictive testing. Here we present an evaluation of the experiences of one group of six people who have tested mutation positive for HD and remain pre-symptomatic. Two partners also attended the session. Observations, evaluation forms and telephone interviews were used in data collection. Interview data was available from five mutation-positive individuals and one partner. Qualitative data were analysed using a thematic framework approach. Responses were overwhelmingly positive, emphasising the importance of a specifically arranged time and space to share experiences in a structured way. This was typically the first time participants had spoken openly with someone in their situation. Narrative facilitation of discussion encouraged participants to re-discover their strengths and resiliences, with similar experiences being discovered through connections with others. The evaluation was successful in implementing group narrative interventions as part of the predictive test counselling support for Huntington’s disease. Participants suggested that the approach could be extended and adopted for other genetic conditions.
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5
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Lêdo S, Ramires A, Leite Â, Dinis MAP, Sequeiros J. Long-term predictors for psychological outcome of pre-symptomatic testing for late-onset neurological diseases. Eur J Med Genet 2018; 61:575-580. [PMID: 29581083 DOI: 10.1016/j.ejmg.2018.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 02/19/2018] [Accepted: 03/21/2018] [Indexed: 01/31/2023]
Abstract
This longitudinal study aimed at determining predicting variables for middle and long-term psychological disturbance due pre-symptomatic testing (PST) for two late-onset neurological diseases, Huntington disease (HD) and TTR (transthyretin protein) familial amyloid polyneuropathy (FAP) Val30Met (now classified as Val50Met). 196 clinical records of persons who performed PST at least three years ago and answered to the two stages of evaluation (before PST and least 3 years after disclosure of results) were analysed. For this purpose, regression analysis was performed, showing that the Positive Symptom Distress Index (PSDI), psychoticism, somatization and paranoid ideation dimensions assume predictive value in the middle and long-term impact for total anxiety and PSDI. The result of PST was not a relevant predictor. The application of an evaluation instrument of various psychopathological dimensions played a fundamental role in the detection of clinical situations that may arise several years later after PST. Attention should be paid to providing psychological support to persons at-risk who, at the pre-test phase, present some psychopathology indices before pursuing with genetic testing.
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Affiliation(s)
- Susana Lêdo
- IBMC - Instituto de Biologia Molecular e Celular, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.
| | - Ana Ramires
- European University, Lisboa, Portugal; GOVCOPP - Research Unit on Governance, Competitiveness and Public Policies, University of Aveiro, Portugal
| | | | - Maria Alzira Pimenta Dinis
- UFP Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa (UFP), Porto, Portugal
| | - Jorge Sequeiros
- IBMC - Instituto de Biologia Molecular e Celular, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal; ICBAS - Instituto de Ciências Biomédicas Salazar, Universidade do Porto, Porto, Portugal
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6
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Sampaio C, Levey J, Klitzman R. Predictive testing and clinical trials in Huntington's disease: An ethical analysis. Mov Disord 2018; 33:243-247. [PMID: 29205501 PMCID: PMC5854324 DOI: 10.1002/mds.27247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/16/2017] [Accepted: 10/22/2017] [Indexed: 02/03/2023] Open
Affiliation(s)
- Cristina Sampaio
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Portugal
| | - Jamie Levey
- CHDI Management/CHDI Foundation, Princeton, NJ, USA
- European Huntington’s Disease Network, University Hospital of Ulm, Ulm, Germany
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7
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Nance MA. Genetic counseling and testing for Huntington's disease: A historical review. Am J Med Genet B Neuropsychiatr Genet 2017; 174:75-92. [PMID: 27174011 DOI: 10.1002/ajmg.b.32453] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 04/15/2016] [Indexed: 12/26/2022]
Abstract
This manuscript describes the ways in which genetic counseling has evolved since John Pearson and Sheldon Reed first promoted "a genetic education" in the 1950s as a voluntary, non-directive clinical tool for permitting individual decision making. It reviews how the emergence of Huntington's disease (HD) registries and patient support organizations, genetic testing, and the discovery of a disease-causing CAG repeat expansion changed the contours of genetic counseling for families with HD. It also reviews the guidelines, outcomes, ethical and laboratory challenges, and uptake of predictive, prenatal, and preimplantation testing, and it casts a vision for how clinicians can better make use of genetic counseling to reach a broader pool of families that may be affected by HD and to ensure that genetic counseling is associated with the best levels of care. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Martha A Nance
- Struthers Parkinson's Center, Golden Valley, Minnesota.,Hennepin County Medical Center, Minneapolis, Minnesota
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8
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Lêdo S, Leite Â, Souto T, Dinis MA, Sequeiros J. Mid- and long-term anxiety levels associated with presymptomatic testing of Huntington's disease, Machado-Joseph disease, and familial amyloid polyneuropathy. ACTA ACUST UNITED AC 2016; 38:113-20. [PMID: 26870910 PMCID: PMC7111364 DOI: 10.1590/1516-4446-2014-1617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/13/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To study anxiety as a variable of the mid- and long-term psychological impact of pre-symptomatic testing for three autosomal dominant late-onset disorders - Huntington's disease (HD), Machado-Joseph disease (MJD) and familial amyloid polyneuropathy (FAP) TTR V30M - in a Portuguese sample. METHODS This cross-sectional study included 203 participants: 170 (83.7%) underwent pre-symptomatic testing for FAP, 29 (14.3%) for HD, and 4 (2%) for MJD. Of the 203 participants, 73 (36.0%) were asymptomatic carriers, 29 (14.5%) were symptomatic carriers, 9 (4.5%) were diagnosed with FAP and had a liver transplant, and 89 (44.5%) were non-carriers. Most were women (58.1%) and married (66.5%). The anxiety variable was assessed using the Zung Self-Rating Anxiety Scale (SAS). RESULTS The anxiety scores were higher for symptomatic carriers and for those who underwent psychological support consultations over the years. For symptomatic carriers, the mean scores were superior to 40 points, which reflects clinical anxiety. CONCLUSION Although it was not possible to differentiate between the mid- and long-term psychological impacts, this study supports the conclusion that the proximity to the age of symptoms onset might be a trigger for anxiety.
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Affiliation(s)
- Susana Lêdo
- Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto , Portugal, Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal.,Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto , Portugal, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
| | - Ângela Leite
- Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto , Portugal, Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal.,Universidade Lusófona do Porto (ULP), Universidade Lusófona do Porto, Porto , Portugal, Universidade Lusófona do Porto (ULP), Porto, Portugal
| | - Teresa Souto
- Universidade Lusófona do Porto (ULP), Universidade Lusófona do Porto, Porto , Portugal, Universidade Lusófona do Porto (ULP), Porto, Portugal
| | - Maria A Dinis
- Universidade Fernando Pessoa (UFP), Unidade de Investigação em Energia, Ambiente e Saúde (FP-ENAS), Laboratório de Investigação em Energia, Ambiente e Saúde Ambiental e Pública (3ERL), Universidade Fernando Pessoa, Porto , Portugal, Unidade de Investigação em Energia, Ambiente e Saúde (FP-ENAS), Laboratório de Investigação em Energia, Ambiente e Saúde Ambiental e Pública (3ERL), Universidade Fernando Pessoa (UFP), Porto, Portugal
| | - Jorge Sequeiros
- Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto , Portugal, Centro de Genética Preditiva e Preventiva (CGPP), Instituto de Biologia Molecular e Celular (IBMC) do Instituto de Investigação e Inovação em Saúde (i3S), Porto, Portugal.,Universidade do Porto, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto , Portugal, Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal
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9
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Impact of Huntington Disease Gene-Positive Status on Pre-Symptomatic Young Adults and Recommendations for Genetic Counselors. J Genet Couns 2016; 25:1188-1197. [PMID: 27103420 DOI: 10.1007/s10897-016-9951-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/18/2016] [Indexed: 01/09/2023]
Abstract
Huntington disease (HD) is an autosomal dominant, progressive neurodegenerative disorder for which there is no cure. Predictive testing for HD is available to asymptomatic at-risk individuals. Approximately half of the population undergoing predictive testing for HD consists of young adults (≤35 years old). Finishing one's education, starting a career, engaging in romantic relationships and becoming a parent are key milestones of young adulthood. We conducted a qualitative study to explore how testing gene-positive for HD influences young adults' attainment of these milestones, and to identify major challenges that pre-symptomatic young adults face to aid the development of targeted genetic counseling. Results of our study demonstrate that 1) knowing one's gene-positive status results in an urgency to reach milestones and positively changes young adults' approach to life; 2) testing positive influences young adults' education and career choices, romantic relationships, and family planning; 3) young adults desire flexible and tailored genetic counseling to address needs and concerns unique to this population. Findings of this study contribute to the understanding of the impact of predictive testing for HD on young adults, and highlight issues unique to this population that call for further research, intervention and advocacy.
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10
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Etchegary H, Fowler K. 'They had the right to know.' Genetic risk and perceptions of responsibility. Psychol Health 2014; 23:707-27. [PMID: 25160812 DOI: 10.1080/14768320701235249] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The idea that people should be responsible for their health is not new. The construction of health as a moral issue has often been applied to voluntary health risks. With the advent of predictive genetic testing, however, people may also bear responsibility for their genetic risks. Drawing upon 24 semi-structured interviews with at risk persons and their family members, this study explored perceptions of responsibility associated with genetic risk for the adult-onset disorder, Huntington disease (HD). Qualitative data analysis suggested that decisions around genetic risk were often influenced by obligations to other family members. Some participants felt responsible to determine their genetic risks through testing, particularly for at risk offsprings. Responsibility to current and future partners, to plan for a future that might include HD and to communicate genetic risk to other family members also emerged as important dimensions of genetic responsibility. It is argued that perceptions of responsibility in this context may constrain some of the choices of those who live with genetic risk having implications for test decisions, post-test adjustment and family relationships.
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Affiliation(s)
- Holly Etchegary
- a Faculty of Social Sciences, School of Psychology, GAP-Santé Research Group , National Institute of Population Health; Faculty of Medicine, Epidemiology & Community Medicine, GeneSens Research Group University of Ottawa , St John's , NL
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11
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Smith RA, Wienke S, Coffman DL. Alpha-1 couples: interpersonal and intrapersonal predictors of spousal communication and stress. J Genet Couns 2014; 23:212-20. [PMID: 23934327 PMCID: PMC3921266 DOI: 10.1007/s10897-013-9639-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 07/30/2013] [Indexed: 10/26/2022]
Abstract
Couples often discuss genetic test results, and then manage their implications together. This interdependence can lead to common, shared experiences, similar intrapersonal processes to manage shared stressors, or interpersonal influences between spouses, leading to different outcomes. This study sought to reveal the intracouple, intrapersonal, and interpersonal influences of genetic stigma and negative feelings on spousal communication and perceived stress with 50 couples in which one spouse is a member of a genetic disease registry. The results were analyzed with dyadic analysis, including multilevel modeling. The findings showed that registered members and their spouses were not statistically different in their mean levels of perceived genetic stigma, negative feelings about alpha-1 antitrypsin deficiency (AATD), conversations with each other about the AATD test results, and their perceived stress. The findings also showed that their intracouple consistencies were not high, and their intrapersonal and interpersonal influences on communication and stress differed. The social implications of genetic research at the interpersonal level are discussed.
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Affiliation(s)
- Rachel A Smith
- Department of Communication Arts & Sciences and Center for Infectious Disease Dynamics, The Pennsylvania State University, University Park, PA, 16803, USA,
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12
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Wedderburn S, Panegyres PK, Andrew S, Goldblatt J, Liebeck T, McGrath F, Wiltshire M, Pestell C, Lee J, Beilby J. Predictive gene testing for Huntington disease and other neurodegenerative disorders. Intern Med J 2013; 43:1272-9. [DOI: 10.1111/imj.12176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 03/18/2013] [Indexed: 11/26/2022]
Affiliation(s)
- S. Wedderburn
- Western Australian Department of Health; Neurosciences Unit; Perth Western Australia Australia
| | - P. K. Panegyres
- Western Australian Department of Health; Neurosciences Unit; Perth Western Australia Australia
- Neurodegenerative Disorders Research Pty Ltd; Perth Western Australia Australia
| | - S. Andrew
- Western Australian Department of Health; Neurosciences Unit; Perth Western Australia Australia
| | - J. Goldblatt
- King Edward Memorial Hospital; Perth Western Australia Australia
| | - T. Liebeck
- Western Australian Department of Health; Neurosciences Unit; Perth Western Australia Australia
| | - F. McGrath
- Western Australian Department of Health; Neurosciences Unit; Perth Western Australia Australia
| | - M. Wiltshire
- Western Australian Department of Health; Neurosciences Unit; Perth Western Australia Australia
| | - C. Pestell
- Western Australian Department of Health; Neurosciences Unit; Perth Western Australia Australia
| | - J. Lee
- Western Australian Department of Health; Neurosciences Unit; Perth Western Australia Australia
| | - J. Beilby
- Molecular Genetics; PathWest; Queen Elizabeth Medical Centre; Perth Western Australia Australia
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13
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Paulsen JS, Nance M, Kim JI, Carlozzi NE, Panegyres PK, Erwin C, Goh A, McCusker E, Williams JK. A review of quality of life after predictive testing for and earlier identification of neurodegenerative diseases. Prog Neurobiol 2013; 110:2-28. [PMID: 24036231 PMCID: PMC3833259 DOI: 10.1016/j.pneurobio.2013.08.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 12/12/2022]
Abstract
The past decade has witnessed an explosion of evidence suggesting that many neurodegenerative diseases can be detected years, if not decades, earlier than previously thought. To date, these scientific advances have not provoked any parallel translational or clinical improvements. There is an urgency to capitalize on this momentum so earlier detection of disease can be more readily translated into improved health-related quality of life for families at risk for, or suffering with, neurodegenerative diseases. In this review, we discuss health-related quality of life (HRQOL) measurement in neurodegenerative diseases and the importance of these "patient reported outcomes" for all clinical research. Next, we address HRQOL following early identification or predictive genetic testing in some neurodegenerative diseases: Huntington disease, Alzheimer's disease, Parkinson's disease, Dementia with Lewy bodies, frontotemporal dementia, amyotrophic lateral sclerosis, prion diseases, hereditary ataxias, Dentatorubral-pallidoluysian atrophy and Wilson's disease. After a brief report of available direct-to-consumer genetic tests, we address the juxtaposition of earlier disease identification with assumed reluctance toward predictive genetic testing. Forty-one studies examining health-related outcomes following predictive genetic testing for neurodegenerative disease suggested that (a) extreme or catastrophic outcomes are rare; (b) consequences commonly include transiently increased anxiety and/or depression; (c) most participants report no regret; (d) many persons report extensive benefits to receiving genetic information; and (e) stigmatization and discrimination for genetic diseases are poorly understood and policy and laws are needed. Caution is appropriate for earlier identification of neurodegenerative diseases but findings suggest further progress is safe, feasible and likely to advance clinical care.
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Affiliation(s)
- Jane S Paulsen
- Department of Neurology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA; Department of Psychiatry, University of Iowa, Carver College of Medicine, Iowa City, IA, USA; Department of Psychology, University of Iowa, Iowa City, IA, USA.
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14
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Forrest Keenan K, Simpson SA, Miedzybrodzka Z, Alexander DA, Semper J. How do partners find out about the risk of Huntington's disease in couple relationships? J Genet Couns 2013; 22:336-44. [PMID: 23297124 DOI: 10.1007/s10897-012-9562-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 12/06/2012] [Indexed: 10/27/2022]
Abstract
Whilst a growing body of work has explored family communication about Huntington's disease and how at-risk individuals learn about their risk, the experience of telling a partner and partners' experiences of finding out about this potentially devastating hereditary illness have received little attention. This study describes the experiences of partners in finding out about Huntington's disease and any impact on couple's relationships/marriages. We undertook a thematic analysis of qualitative interviews which explored the dynamics of partners' marriages after predictive testing and partners' views of genetic counseling. A main theme from partners' accounts was how they found out about their spouse's risk of Huntington's disease and the impact this had on marital relations. The analysis revealed four types of disclosure experiences: (1) marital secrets; (2) alerting, but not telling; (3) knowing and seeing; (4) marital ignorance. Our findings demonstrate that partners' experiences of (non)disclosure about the risk of HD within marriages is an important factor which contributes to couples' coping or marital problems. Exploring how spouses found out about their partner's risk of HD will illuminate issues about a couple's past and future patterns of communication and their coping strategies. A practical and ethical implication is the extent to which genetic counselors should inform partners about the course and nature of Huntington's disease when a partner is the support person for the individual being tested.
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Affiliation(s)
- Karen Forrest Keenan
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK.
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15
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Yoshida K, Ohata T, Muto K, Tsuchiya A, Sawada J, Hazama T, Ikeda SI, Toda T. [Survey on the attitude toward genetic testing of neurologists certified by the Japanese Society of Neurology]. Rinsho Shinkeigaku 2013; 53:337-344. [PMID: 23719980 DOI: 10.5692/clinicalneurol.53.337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
To clarify the attitude toward genetic testing for neuromuscular diseases, a questionnaire was sent to 4,762 neurologists certified by the Japanese Society of Neurology. By December 21, 2011, 1,493 questionnaires (31.4%) were returned. Of these, 1,233 (82.6%) had experienced genetic testing, but only 396 (26.5%) had referred to the guideline for genetic testing of the Japanese Society of Neurology (2009). The numbers of respondents who were positive, or more positive than negative for genetic testing for myotonic dystrophy type 1 (DM1), Huntington's disease (HD), and familial amyloid polyneuropathy (FAP) were 753 (50.4%), 915 (61.3%), and 980 (65.6%), respectively. The predominant reason for a positive attitude toward genetic testing was to confirm or exclude the diagnosis. Conversely, the predominant reason for a negative attitude toward genetic testing differed between the diseases. For DM1, it was to confirm the diagnosis without genetic testing. For HD, it was that genetic testing would not result in effective prevention or therapy. In FAP, it was that post-testing psychosocial support for the patient and their family was difficult. Common to DM1, HD, and FAP, a significant number of respondents (approximately 60%) felt it difficult to explain the negative aspects that might occur after the disclosure of test results. Concerning predictive or prenatal genetic testing, most respondents referred at-risk individuals to specialized genetic counseling clinics. In general, neurologists are likely to conduct genetic testing properly in consideration not only of the characteristics of the diseases but also of the circumstances of each patient and his or her family. To support neurologists who are involved in genetic testing, the guidelines should be more easily accessible. Many respondents wanted information on the institutions that provide genetic counseling and testing; however, financial support to such institutions is indispensable for fulfilling this requirement.
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Affiliation(s)
- Kunihiro Yoshida
- Department of Brain Disease Research, Shinshu University School of Medicine
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Andersson PL, Juth N, Petersén Å, Graff C, Edberg AK. Ethical aspects of undergoing a predictive genetic testing for Huntington's disease. Nurs Ethics 2012; 20:189-99. [DOI: 10.1177/0969733012452686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to describe the experiences of undergoing a presymptomatic genetic test for the hereditary and fatal Huntington’s disease, using a case study approach. The study was based on 18 interviews with a young woman and her husband from the decision to undergo the test, to receiving the results and trying to adapt to them, which were analysed using a life history approach. The findings show that the process of undergoing a presymptomatic test involves several closely connected ethical and medical questions, such as the reason for the test, the consequences of the test results and how health-care services can be developed to support people in this situation.
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MacLeod R, Tibben A, Frontali M, Evers-Kiebooms G, Jones A, Martinez-Descales A, Roos RA. Recommendations for the predictive genetic test in Huntington's disease. Clin Genet 2012; 83:221-31. [PMID: 22642570 DOI: 10.1111/j.1399-0004.2012.01900.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 05/08/2012] [Accepted: 05/22/2012] [Indexed: 01/27/2023]
Affiliation(s)
- R MacLeod
- Genetic Medicine, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
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18
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Williams JK, Erwin C, Juhl A, Mills J, Brossman B, Paulsen JS. Personal factors associated with reported benefits of Huntington disease family history or genetic testing. Genet Test Mol Biomarkers 2010; 14:629-36. [PMID: 20722493 PMCID: PMC2957234 DOI: 10.1089/gtmb.2010.0065] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS A family history of Huntington disease (HD) or receiving results of HD predictive genetic testing can influence individual well-being, family relationships, and social interactions in positive and negative ways. The aim of this study was to examine benefits reported by people with an HD family history or those who have undergone predictive HD testing, as well as the personal variables associated with perceived benefits. METHODS Seventy-four of 433 people completing the International Response of a Sample Population to HD risk (I-RESPOND-HD) survey reported benefits. Knowledge and understanding was perceived as the most common benefit from participants in both groups. The next most frequent perceived benefits from a family history were connecting with others and achieving life meaning and insights. The next most common perceived benefits from genetic testing were life planning and social support. The least common perceived benefit for both groups was renewed hope and optimism. Older age and spirituality were significantly associated with benefits in both groups. CONCLUSIONS Perceptions of benefit may not be as likely until later years in people with prodromal HD. A developed sense of spirituality is identified as a personal resource associated with the perception of benefit from genetic testing for HD. Associations among spirituality, perceived benefits, and other indicators of personal and family well-being may be useful in genetic counseling and health care of people with prodromal HD.
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Affiliation(s)
| | - Cheryl Erwin
- Department of Family Medicine, John P. McGovern Center for Health, Humanities, and the Human Spirit, University of Texas Medical School of Houston, Houston, Texas
| | - Andrew Juhl
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - James Mills
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
| | - Bradley Brossman
- TIMSS and PIRLS International Study Center, Boston College, Boston, Massachusetts
| | - Jane S. Paulsen
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, Iowa
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Williams JK, Hamilton R, Nehl C, McGonigal-Kenney M, Schutte DL, Sparbel K, Birrer E, Tripp-Reimer T, Friedrich R, Penziner E, Jarmon L, Paulsen J. "No one else sees the difference: "family members' perceptions of changes in persons with preclinical Huntington disease. Am J Med Genet B Neuropsychiatr Genet 2007; 144B:636-41. [PMID: 17219384 DOI: 10.1002/ajmg.b.30479] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Manifestations of Huntington disease (HD) prior to clinical diagnosis are not well understood. This study documents adult family members' perceptions of changes and their attempts to manage these changes in persons who had received a positive predictive molecular HD test prior to clinical diagnosis. Data were obtained from 19 adult family members in six focus groups in the US and Canada and one individual interview in the US. Changes reported by family members included problems in cognition and behavior, which are consistent with prior reports. In addition, family members observed changes in motor functioning, the ability to complete usual activities at work or at home, and interpersonal relationships with family and friends. Family members attempted to manage these changes by taking on new responsibilities and preparing for future caregiving. Lack of information about preclinical HD, difficulty in understanding changes that may represent early stages of HD, and efforts to maintain secrecy of the preclinical HD situation contribute to compromising the abilities of family members to respond to changes in the person with preclinical HD. Findings provide insights into alterations in cognition, behavior, and functioning observed by the family members prior to clinical diagnosis. Findings further support the need for a more comprehensive assessment and management of early HD symptoms as well as support for family members.
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Affiliation(s)
- Janet K Williams
- College of Nursing, University of Iowa, Iowa City, Iowa 52242, USA.
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Abstract
Worldwide, predictive testing for Huntington's disease has become an accepted clinical application that has allowed many individuals from HD-families to proceed with their life without the uncertainty of being at risk. International guidelines have extensively contributed to establishing counselling programmes of high quality, and have served as a model for other genetic disorders. Psychological follow-up studies have increased the insight into the far-reaching impact of test results for all individuals involved. Although the guidelines have served as a useful frame of reference, clinical experience has shown the importance of a case-by-case approach to do justice to the specific needs of the individual test candidate. Issues such as ambiguous test results, lack of awareness in a test candidate of early signs of the disease, non-compliance to the test protocol, or the test candidate's need for information on the relationship between age at onset and CAG-repeat require careful consideration. Receiving a test result is only one of the transition points in the life of an individual at risk; such result needs to be valued from a life-cycle perspective.
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Affiliation(s)
- Aad Tibben
- Centre for Human and Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands.
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Decruyenaere M, Evers-Kiebooms G, Boogaerts A, Philippe K, Demyttenaere K, Dom R, Vandenberghe W, Fryns JP. The complexity of reproductive decision-making in asymptomatic carriers of the Huntington mutation. Eur J Hum Genet 2007; 15:453-62. [PMID: 17245406 DOI: 10.1038/sj.ejhg.5201774] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to describe reproductive decisions in mutation carriers after predictive testing for Huntington's disease (HD) and to identify factors that play a role in decision-making. In 1987-2004, 245 individuals received a predictive test result; 89 of them were carriers and seven received an equivocal result. Quantitative data on reproductive behaviour have been collected during all follow-up contacts. The follow-up time in this study was 1-16 years (mean: 7.1 years). Qualitative data on reproductive decision-making have been collected by the means of semistructured interviews during the 5-year follow-up study. For 46 carriers and two persons with an equivocal result, family planning was one of the motives for predictive testing. In this group, slightly more than half of the carriers (58%) had chosen to have children with prenatal diagnosis or preimplantation genetic diagnosis and about one in three (35%) decided to have no children anymore after the test. A minority (7%) was undecided or had no children for other reasons. Factors playing a role in the decision-making process were the carrier's sex, ethical issues about PD and PGD, the strength of the desire to have children, illness representations including personal experiences with HD in the family and the technological imperative. Some of these elements were in conflict and induced ambivalence towards reproductive choices. The results illustrate the complexity of the decision-making process and the necessity of in-depth counselling. Counselling should pay special attention to conflicting values and beliefs and to all kinds of pressure.
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Peterson SK. The role of the family in genetic testing: theoretical perspectives, current knowledge, and future directions. HEALTH EDUCATION & BEHAVIOR 2005; 32:627-39. [PMID: 16148209 DOI: 10.1177/1090198105278751] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article addresses conceptual challenges and theoretical approaches for examining the role of the family in responding and adapting to genetic testing for inherited conditions. Using a family systems perspective, family-based constructs that are relevant to genetic testing may be organized into three domains: family communication, organization and structure of family relationships, and health-related cognitions and beliefs shared within families. Empirical findings are presented from key content areas in family-based genetics research, including family communication, how genetic testing affects family relationships, psychological responses to genetic testing in the family context, and family-based influences on health decisions. Future research should explore decision making about genetic testing or behavior change specifically within the context of the family system and should identify family-based determinants of genetic testing outcomes.
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Affiliation(s)
- Susan K Peterson
- Department of Behavioral Science-Unit1330, University of Texas, M. D. AndersonCancer Center, Houston, TX 77230-1439, USA.
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Decruyenaere M, Evers-Kiebooms G, Boogaerts A, Demyttenaere K, Dom R, Fryns JP. Partners of mutation-carriers for Huntington's disease: forgotten persons? Eur J Hum Genet 2005; 13:1077-85. [PMID: 15999117 DOI: 10.1038/sj.ejhg.5201462] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This study focuses on psychological distress and coping strategies in partners of tested persons 5 years after predictive testing for Huntington's disease. A total of 16 carrier-couples and 17 noncarrier-couples participated in the study. Self-report questionnaires were used, assessing depression level, anxiety, intrusive and avoidance thoughts and coping strategies. Partners of carriers have as much distress as carriers, and for some distress variables even more (P<0.05-0.001). They clearly experience more psychological distress than noncarriers' partners, as expected (P<0.05-0.001). Regarding coping strategies, carriers' partners adopt more passive strategies (passive-regressive and avoiding reactions; P<0.05) and less active strategies (social support seeking and problem solving; P<0.05-0.001), compared to carriers. For both carriers and partners, the adoption of more passive strategies for coping was associated with more distress and the use of more active strategies with less distress (for carriers: P<0.05-0.001; for carriers' partners: P<0.05). The presence of children before predictive testing was an additional result-specific distress factor in carriers and their partners. In conclusion, carriers' partners have at least as much psychological distress as carriers, but partners have the tendency to draw back. The results suggest that the grief of carriers' partners may be 'disenfranchised', or not socially recognised, as if they have no right to mourn. We moreover interpreted the results referring to concepts such as anticipatory grief, psychological defences, dissonance processes and imbalanced partner relationship. Finally, we formulated some implications for genetic counselling.
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Affiliation(s)
- Marleen Decruyenaere
- Psychosocial Genetics Unit, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium.
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