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Gatt-Rutter T, Forrest L, Sexton A, Isbister J. Consumer attitudes and preferences toward psychiatric genetic counselling and educational resources: A scoping review. PATIENT EDUCATION AND COUNSELING 2024; 123:108229. [PMID: 38461792 DOI: 10.1016/j.pec.2024.108229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/20/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION The etiology of psychiatric disorders is multifactorial including genomic and environmental risk factors. Psychiatric genetic counseling is an emerging field that may promote processes of adaptation to, and the management of, psychiatric disorders. Many countries lack dedicated services leading to a gap in care. This scoping review will inform the development of psychiatric genetics-based educational resources. OBJECTIVES To explore individuals with a psychiatric disorder and their relatives' attitudes and beliefs toward psychiatric genetics, genetic counseling, and genetics-based education. To evaluate how best to convey education to consumers. METHOD Database literature searches occurred on May 2nd, 2023, using PubMed, Medline, and PsycINFO. Reviews, letters to the editor, case reports, and publications before 2003 were excluded. RESULTS Twenty-four papers met the inclusion criteria. Results suggest individuals with a psychiatric disorder and their relatives tended to overestimate risk, and express concern about reproductive decision- making. Genetic counseling and educational resources were perceived to be useful and empowering. CONCLUSION Affected individuals and relatives are interested in gaining greater insight into their own and/or their relative's psychiatric disorder, management strategies, and understanding familial risks. PRACTICE IMPLICATIONS The evidence from this review may inform the development of genetics-based educational resources or guide future research.
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Affiliation(s)
- Tessa Gatt-Rutter
- Department of Paediatrics, University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia
| | - Laura Forrest
- Genomic Medicine & Parkville Familial Cancer Centre, Royal Melbourne Hospital & Peter MacCallum Cancer Centre, Parkville, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Adrienne Sexton
- Genomic Medicine & Parkville Familial Cancer Centre, Royal Melbourne Hospital & Peter MacCallum Cancer Centre, Parkville, Australia; Genetic Counselling Service, Epworth Freemasons, East Melbourne, Australia; Department of Medicine - Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia
| | - Joanne Isbister
- Department of Paediatrics, University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Australia; Genomic Medicine & Parkville Familial Cancer Centre, Royal Melbourne Hospital & Peter MacCallum Cancer Centre, Parkville, Australia.
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2
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Choi SW, García-González J, Ruan Y, Wu HM, Porras C, Johnson J, Hoggart CJ, O'Reilly PF. PRSet: Pathway-based polygenic risk score analyses and software. PLoS Genet 2023; 19:e1010624. [PMID: 36749789 PMCID: PMC9937466 DOI: 10.1371/journal.pgen.1010624] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 02/17/2023] [Accepted: 01/19/2023] [Indexed: 02/08/2023] Open
Abstract
Polygenic risk scores (PRSs) have been among the leading advances in biomedicine in recent years. As a proxy of genetic liability, PRSs are utilised across multiple fields and applications. While numerous statistical and machine learning methods have been developed to optimise their predictive accuracy, these typically distil genetic liability to a single number based on aggregation of an individual's genome-wide risk alleles. This results in a key loss of information about an individual's genetic profile, which could be critical given the functional sub-structure of the genome and the heterogeneity of complex disease. In this manuscript, we introduce a 'pathway polygenic' paradigm of disease risk, in which multiple genetic liabilities underlie complex diseases, rather than a single genome-wide liability. We describe a method and accompanying software, PRSet, for computing and analysing pathway-based PRSs, in which polygenic scores are calculated across genomic pathways for each individual. We evaluate the potential of pathway PRSs in two distinct ways, creating two major sections: (1) In the first section, we benchmark PRSet as a pathway enrichment tool, evaluating its capacity to capture GWAS signal in pathways. We find that for target sample sizes of >10,000 individuals, pathway PRSs have similar power for evaluating pathway enrichment as leading methods MAGMA and LD score regression, with the distinct advantage of providing individual-level estimates of genetic liability for each pathway -opening up a range of pathway-based PRS applications, (2) In the second section, we evaluate the performance of pathway PRSs for disease stratification. We show that using a supervised disease stratification approach, pathway PRSs (computed by PRSet) outperform two standard genome-wide PRSs (computed by C+T and lassosum) for classifying disease subtypes in 20 of 21 scenarios tested. As the definition and functional annotation of pathways becomes increasingly refined, we expect pathway PRSs to offer key insights into the heterogeneity of complex disease and treatment response, to generate biologically tractable therapeutic targets from polygenic signal, and, ultimately, to provide a powerful path to precision medicine.
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Affiliation(s)
- Shing Wan Choi
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York City, New York, United States of America
| | - Judit García-González
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York City, New York, United States of America
| | - Yunfeng Ruan
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
| | - Hei Man Wu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York City, New York, United States of America
| | - Christian Porras
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York City, New York, United States of America
| | - Jessica Johnson
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York City, New York, United States of America
| | - Clive J Hoggart
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York City, New York, United States of America
| | - Paul F O'Reilly
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York City, New York, United States of America
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3
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Raffaele G, Blout Zawatsky CL, Cottrell C, Santoro SL. Assessing co-occurring mental health conditions in a multidisciplinary Down syndrome clinic and the role of family history. Am J Med Genet A 2022; 188:3162-3171. [PMID: 36150133 DOI: 10.1002/ajmg.a.62948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/21/2022] [Accepted: 07/22/2022] [Indexed: 01/31/2023]
Abstract
Compared to the general population, individuals with Down syndrome (DS) are at a significantly increased risk to develop mental health conditions. This study sought to examine individuals with DS and co-existing mental health comorbidities at one DS specialty clinic. Retrospective chart review of medical records including demographics, genetic testing history, personal and familial mental health history, referrals for mental health indications, and recommendations was performed. Summary statistics, logistic regression, and log of odds were converted to odd ratios to assess associations and significance. The charts of 327 patients, average 19.4 years of age (1-70), were reviewed. Nearly half the participants (42.2%) had at least one diagnosis of a mental health condition. Those with a family history were significantly more likely to have a personal diagnosis of a mental health condition than those without a family history (p < 0.01). Moreover, those who completed referrals often received medical management recommendations (86%). This study highlights the prevalence of mental health comorbidities among individuals with DS, and the referral process for mental health conditions, at one DS specialty clinic. Further research is needed to investigate our family history findings, and to determine if these results are generalizable across other DS clinics.
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Affiliation(s)
| | - Carrie L Blout Zawatsky
- Institute of Health Professions, MGH, Boston, Massachusetts, USA.,Genomes2People, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA.,Ariadne Labs, Boston, Massachusetts, USA
| | - Clorinda Cottrell
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephanie L Santoro
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts General for Children, Boston, Massachusetts, USA
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4
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Ribbans WJ, September AV, Collins M. Tendon and Ligament Genetics: How Do They Contribute to Disease and Injury? A Narrative Review. Life (Basel) 2022; 12:life12050663. [PMID: 35629331 PMCID: PMC9147569 DOI: 10.3390/life12050663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/15/2022] Open
Abstract
A significant proportion of patients requiring musculoskeletal management present with tendon and ligament pathology. Our understanding of the intrinsic and extrinsic mechanisms that lead to such disabilities is increasing. However, the complexity underpinning these interactive multifactorial elements is still not fully characterised. Evidence highlighting the genetic components, either reducing or increasing susceptibility to injury, is increasing. This review examines the present understanding of the role genetic variations contribute to tendon and ligament injury risk. It examines the different elements of tendon and ligament structure and considers our knowledge of genetic influence on form, function, ability to withstand load, and undertake repair or regeneration. The role of epigenetic factors in modifying gene expression in these structures is also explored. It considers the challenges to interpreting present knowledge, the requirements, and likely pathways for future research, and whether such information has reached the point of clinical utility.
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Affiliation(s)
- William J. Ribbans
- School of Health, The University of Northampton, Northampton NN1 5PH, UK
- The County Clinic, Northampton NN1 5DB, UK
- Correspondence: ; Tel.: +44-1604-795414
| | - Alison V. September
- Division of Physiological Sciences, Department of Human Biology, Health Sciences Faculty, University of Cape Town, Cape Town 7700, South Africa; (A.V.S.); (M.C.)
- Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Health Sciences Faculty, University of Cape Town, Cape Town 7700, South Africa
- International Federation of Sports Medicine (FIMS), Collaborative Centre of Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town 7700, South Africa
| | - Malcolm Collins
- Division of Physiological Sciences, Department of Human Biology, Health Sciences Faculty, University of Cape Town, Cape Town 7700, South Africa; (A.V.S.); (M.C.)
- Health Through Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, Health Sciences Faculty, University of Cape Town, Cape Town 7700, South Africa
- International Federation of Sports Medicine (FIMS), Collaborative Centre of Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town 7700, South Africa
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Van den Adel B, Inglis A, Austin J. An internship in psychiatric genetic counseling: Impact on genetic counseling graduates' practice and career choices. J Genet Couns 2022; 31:1071-1079. [PMID: 35438217 DOI: 10.1002/jgc4.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/18/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
Though psychiatric genetic counseling has been shown to have meaningful positive impacts on patient outcomes, there is currently only one specialist psychiatric genetic counseling clinic (located in Vancouver, BC). The service is inconsistently offered elsewhere, leaving this patient population largely underserved. In an effort to expand psychiatric genetic counseling, the clinic in Vancouver has been providing specialist internship training to genetic counseling students since 2012. This study explored the impact of the internship training on genetic counseling graduates' careers. Using an interpretive description approach, we recorded and transcribed interviews with past interns. Coding and data analysis were conducted concurrently. The interview guide was iteratively revised through the interview process and memoing was used to record ideas about the data and interviews throughout. From interviews with 15 past interns, we generated a theoretical model-'a fragile dream, easily broken'-describing the impact of the training on participants' careers. Completing an internship in psychiatric genetic counseling positively influenced participants' desire to provide psychiatric genetic counseling; however, most were unable to find work in the subspecialty. Some participants made efforts to create specialist positions for themselves, but setbacks and hurdles left many feeling defeated, resulting in them accepting established roles in other disciplines. We contextualize our findings in a discussion of what may be needed in order to successfully expand psychiatric genetic counseling.
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Affiliation(s)
- Brianna Van den Adel
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Angela Inglis
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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6
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Zwicker A, LeBlanc MA, Pavlova B, Alda M, Denovan-Wright EM, Uher R, Austin JC. Genetic counselling for the prevention of mental health consequences of cannabis use: A randomized controlled trial-within-cohort. Early Interv Psychiatry 2021; 15:1306-1314. [PMID: 33242924 DOI: 10.1111/eip.13082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/10/2020] [Accepted: 11/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cannabis use is a risk factor for severe mental illness. However, cannabis does not affect everyone equally. Genetic information may help identify individuals who are more vulnerable to the harmful effects of cannabis on mental health. A common genetic variant within the AKT1 gene selectively increases risk of psychosis, only among those who use cannabis. Therapeutically oriented genetic counselling may enable us to reduce cannabis exposure among genetically sensitive individuals. METHODS Using a trial-within-cohort design, we aim to test if genetic counselling, including the option to receive AKT1 rs2494732 genotype, reduces cannabis use. To this end, we have designed a genetic counselling intervention: Interdisciplinary approach to Maximize Adolescent potential: Genetic counselling Intervention to reduce Negative Environmental effects (IMAGINE). RESULTS IMAGINE will be implemented in a cohort of children and youth enriched for familial risk for major mood and psychotic disorders. Approximately 110 eligible individuals aged 12-21 years will be randomized in a 1:1 ratio to be offered a single genetic counselling session with a board-certified genetic counsellor, or not. Allocated youth will also be invited to attend a follow-up session approximately 1 month following the intervention. The primary outcome will be cannabis use (measured by self-report or urine screen) at subsequent annual assessments as part of the larger cohort study. Secondary outcomes include intervention acceptability and psychopathology. CONCLUSION This study represents the first translational application of a gene-environment interaction to improve mental health and test an intervention with potential public health benefits. This study is registered with clinicaltrials.gov (NCT03601026).
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Affiliation(s)
- Alyson Zwicker
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Marissa A LeBlanc
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Psychiatry, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jehannine C Austin
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
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7
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Rowlatt AE, McAllister M, Cuthbert A. Attitudes toward offering genetic counseling for psychiatric conditions among genetics healthcare practitioners in the United Kingdom: A qualitative study. J Genet Couns 2021; 31:279-290. [PMID: 34363721 DOI: 10.1002/jgc4.1492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 07/06/2021] [Accepted: 07/18/2021] [Indexed: 02/06/2023]
Abstract
Psychiatric conditions affect a large proportion of the population. High heritability estimates have been reported for commonly diagnosed conditions, suggesting both environmental factors and genetic variation significantly contribute to the chance of psychiatric outcomes. Despite growing interest in the provision and receipt of genetic counseling services for these conditions, such specialized interventions are not routinely available in most healthcare systems, including in the United Kingdom (UK). This study examined the attitudes of fourteen National Health Service employed genetic counselors and clinical geneticists, from seven regional genetic centers, toward offering psychiatric genetic counseling (PGC) in the UK. A qualitative methodology was adopted and individual semi-structured interviews were conducted either by telephone or face-to-face, audio recorded, transcribed in full and analyzed using thematic analysis. Participants' attitudes were organized under three themes: "Demand," "Readiness to Provide Support," and "Patient Experience." Participants cited key informational and resource needs which included increased workforce capacity, access to further psychological support for patients and more knowledge about the following: specific genes involved, available genetic testing, recurrence/occurrence risk figures, clinical manifestations, diagnostic criteria, patient concerns associated with the impact of psychiatric conditions and interpersonal skills. While some participants appreciated the value of PGC, some reported apprehension and raised concerns around a lack of available genetic testing, the perceived utility of current management options, and a potential negative psychological impact of PGC. This study identified important barriers to the delivery of PGC in the UK by genetics healthcare practitioners. Our findings highlight the importance of a collaborative, multidisciplinary approach to delivering this intervention and the need for additional training. Further research is required to better understand demand for, nature of, and barriers to provision of PGC in the UK, particularly in terms of genetic counselors' perceptions of their role.
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Affiliation(s)
- Amy E Rowlatt
- Centre for Medical Education, Cardiff University, Cardiff, UK.,MRC Institute for Genetics and Molecular Medicine, The University of Edinburgh, Edinburgh, UK
| | | | - Andrew Cuthbert
- MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, UK
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8
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Knowledge Formation in Systemic Counselling Trainees from Germany: A Pilot Study from a Competence-Based Perspective. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2021. [DOI: 10.1007/s10447-021-09443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractThis pilot study has two areas of focus. It examines how the knowledge and competences of twelve Master’s-level systemic counselling trainees are connected, and how well their own assessment of their competence corresponds to external assessment. Methodologically, three instruments were used: first, an instrument to measure their explicit knowledge; second, videos of consultations with simulated clients to measure their competence in practice; third, a self-assessment measure to explore how externally assessed competence corresponds to self-assessment. The results show no indication that knowledge is related to externally assessed competence. Furthermore, their self-assessment did not show any systematic connection to the external assessment. The study concludes that the development of systemic counselling skills is a long-term process of theory acquisition, practise, and reflection. Important reflection processes can be stimulated by self-assessment. However, such assessments are not sufficient to capture the quality and scope of competence.
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Hara T, Toyoshima M, Hisano Y, Balan S, Iwayama Y, Aono H, Futamura Y, Osada H, Owada Y, Yoshikawa T. Glyoxalase I disruption and external carbonyl stress impair mitochondrial function in human induced pluripotent stem cells and derived neurons. Transl Psychiatry 2021; 11:275. [PMID: 33966051 PMCID: PMC8106684 DOI: 10.1038/s41398-021-01392-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/09/2021] [Accepted: 04/19/2021] [Indexed: 12/14/2022] Open
Abstract
Carbonyl stress, a specific form of oxidative stress, is reported to be involved in the pathophysiology of schizophrenia; however, little is known regarding the underlying mechanism. Here, we found that disruption of GLO1, the gene encoding a major catabolic enzyme scavenging the carbonyl group, increases vulnerability to external carbonyl stress, leading to abnormal phenotypes in human induced pluripotent stem cells (hiPSCs). The viability of GLO1 knockout (KO)-hiPSCs decreased and activity of caspase-3 was increased upon addition of methylglyoxal (MGO), a reactive carbonyl compound. In the GLO1 KO-hiPSC-derived neurons, MGO administration impaired neurite extension and cell migration. Further, accumulation of methylglyoxal-derived hydroimidazolone (MG-H1; a derivative of MGO)-modified proteins was detected in isolated mitochondria. Mitochondrial dysfunction, including diminished membrane potential and dampened respiratory function, was observed in the GLO1 KO-hiPSCs and derived neurons after addition of MGO and hence might be the mechanism underlying the effects of carbonyl stress. The susceptibility to MGO was partially rescued by the administration of pyridoxamine, a carbonyl scavenger. Our observations can be used for designing an intervention strategy for diseases, particularly those induced by enhanced carbonyl stress or oxidative stress.
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Affiliation(s)
- Tomonori Hara
- grid.474690.8Laboratory of Molecular Psychiatry, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan ,grid.69566.3a0000 0001 2248 6943Department of Organ Anatomy, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575 Japan
| | - Manabu Toyoshima
- grid.474690.8Laboratory of Molecular Psychiatry, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan
| | - Yasuko Hisano
- grid.474690.8Laboratory of Molecular Psychiatry, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan
| | - Shabeesh Balan
- grid.474690.8Laboratory of Molecular Psychiatry, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan ,Neuroscience Research Laboratory, Institute of Mental Health and Neurosciences (IMHANS), Kozhikode, Kerala 673008 India
| | - Yoshimi Iwayama
- grid.474690.8Support Unit for Bio-Material Analysis, Research Division, RIKEN Center for Brain Science, Wako, Saitama 351-0198 Japan
| | - Harumi Aono
- grid.509461.fChemical Biology Research Group, RIKEN Center for Sustainable Resource Science, Wako, Saitama 351-0198 Japan
| | - Yushi Futamura
- grid.509461.fChemical Biology Research Group, RIKEN Center for Sustainable Resource Science, Wako, Saitama 351-0198 Japan
| | - Hiroyuki Osada
- grid.509461.fChemical Biology Research Group, RIKEN Center for Sustainable Resource Science, Wako, Saitama 351-0198 Japan
| | - Yuji Owada
- grid.69566.3a0000 0001 2248 6943Department of Organ Anatomy, Tohoku University Graduate School of Medicine, Sendai, Miyagi 980-8575 Japan
| | - Takeo Yoshikawa
- Laboratory of Molecular Psychiatry, RIKEN Center for Brain Science, Wako, Saitama, 351-0198, Japan.
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10
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Padula CB, Hansen A, Hughes RL, McNerney MW. Dimensions of Craving Interact with COMT Genotype to Predict Relapse in Individuals with Alcohol Use Disorder Six Months after Treatment. Brain Sci 2021; 11:62. [PMID: 33419001 PMCID: PMC7825287 DOI: 10.3390/brainsci11010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/28/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022] Open
Abstract
(1) Background: Alcohol use disorder (AUD) is associated with poor medical, psychological, and psychosocial outcomes and approximately 60% of individuals with AUD relapse six months after treatment. Craving is a core aspect of AUD and associated with high risk of relapse. One promising avenue to improve outcomes may be in understanding the relationship between COMT genotype, craving, and treatment outcomes. (2) Methods: To this end, we assessed craving, recent drinking history, and impulsivity in 70 individuals with AUD undergoing a standard course of treatment at a regional Veteran Affairs (VA) medical center. Saliva samples were collected to determine COMT genotype. In this prospective observational study, participants were followed for six months to determine who went on to relapse after treatment. (3) Results: Results revealed a significant interaction between craving and catechol-O-methyltransferse (COMT) genotype in predicting relapse. Post hoc exploratory analyses indicated that Met/Met homozygotes reported the highest levels of craving, and craving was associated with recent drinking history. Among Val/Val homozygotes, who had higher rates of relapse, craving was associated with impulsivity. (4) Conclusions: These associations highlight that specific profiles of psychological and biological factors may be important in understanding which individuals are at highest risk of relapse following treatment. Future studies that build on these findings are warranted.
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Affiliation(s)
- Claudia B. Padula
- VA Palo Alto Health Care System, Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, CA 94304, USA; (R.L.H.); (M.W.M.)
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA;
| | - Annika Hansen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA;
| | - Rachel L. Hughes
- VA Palo Alto Health Care System, Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, CA 94304, USA; (R.L.H.); (M.W.M.)
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA;
| | - M. Windy McNerney
- VA Palo Alto Health Care System, Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto, CA 94304, USA; (R.L.H.); (M.W.M.)
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA;
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11
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Polygenic risk scores for genetic counseling in psychiatry: Lessons learned from other fields of medicine. Neurosci Biobehav Rev 2020; 121:119-127. [PMID: 33301779 DOI: 10.1016/j.neubiorev.2020.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/17/2020] [Accepted: 11/27/2020] [Indexed: 12/16/2022]
Abstract
Polygenic risk scores (PRS) may aid in the identification of individuals at-risk for psychiatric disorders, treatment optimization, and increase in prognostic accuracy. PRS may also add significant value to genetic counseling. Thus far, integration of PRSs in genetic counseling sessions remains problematic because of uncertainties in risk prediction and other concerns. Here, we review the current utility of PRSs in the context of clinical psychiatry. By comprehensively appraising the literature in other fields of medicine including breast cancer, Alzheimer's Disease, and cardiovascular disease, we outline several lessons learned that could be applied to future studies and may thus benefit the incorporation of PRS in psychiatric genetic counseling. These include integrating PRS with environmental factors (e.g. lifestyle), setting up large-scale studies, and applying reproducible methods allowing for cross-validation between cohorts. We conclude that psychiatry may benefit from experiences in these fields. PRS may in future have a role in genetic counseling in clinical psychiatric practice, by advancing prevention strategies and treatment decision-making, thus promoting quality of life for (potentially) affected individuals.
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12
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Michael JE, Bulik CM, Hart SJ, Doyle L, Austin J. Perceptions of genetic risk, testing, and counseling among individuals with eating disorders. Int J Eat Disord 2020; 53:1496-1505. [PMID: 32666600 DOI: 10.1002/eat.23333] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Eating disorders develop as a result of genetic and environmental factors. Given that they are multifactorial conditions with a genetic component, they fall within the scope of practice for genetic counseling, but people with these conditions are rarely referred. The purpose of this study was to explore the perceptions of causes of eating disorders, recurrence risk, and interest in genetic counseling and testing among individuals with eating disorders. METHOD An online survey comprising both multiple choice and free form text questions, vignettes about genetic counseling, and the ED100K (validated eating disorder diagnostic questionnaire) was shared via support organizations and prominent bloggers in the eating disorders community to recruit individuals with a personal history of an eating disorder from November 2018 to February 2019. RESULTS In total, 107 participants completed the survey. They perceived that both experiences and genetics were important factors in the development of their eating disorder. All responding participants overestimated the risk for recurrence of eating disorders in children, often by a large margin, and a notable minority reported that their experience with an eating disorder had a negative influence on their childbearing decisions. After imagined experience of genetic counseling, participants reported significantly decreased feelings of stigma, shame, and guilt. Most participants expressed interest in genetic counseling; fewer were interested in genetic testing. DISCUSSION Genetic counseling may benefit individuals with eating disorders by providing accurate recurrence risk information and reducing feelings of guilt, stigma, and shame, which may in turn encourage earlier support seeking and recovery.
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Affiliation(s)
- Julianne E Michael
- Genetic Counseling Program, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.,Department of Medical Genetics and Genomics, Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sarah J Hart
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Lauren Doyle
- Genetic Counseling Program, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Jehannine Austin
- Departments of Psychiatry and Medical Genetics, BC Mental Health and Substance Use Services Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Meiser B, Guo XY, Putt S, Fullerton JM, Schofield PR, Mitchell PB, Yanes T. Psychosocial implications of living with familial risk of a psychiatric disorder and attitudes to psychiatric genetic testing: A systematic review of the literature. Am J Med Genet B Neuropsychiatr Genet 2020; 183:277-288. [PMID: 32369270 DOI: 10.1002/ajmg.b.32786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 02/25/2020] [Accepted: 03/09/2020] [Indexed: 01/12/2023]
Abstract
The aim of this systematic review was to synthesize the existing evidence documenting the psychosocial implications of living with a familial risk of an adult-onset psychiatric disorder. Six databases were searched systematically to identify qualitative and quantitative studies, which explored perspectives of those at increased risk for psychiatric disorders, as well as the general public. Thematic analysis was used to identify major themes. Thirty-five articles met the eligibility criteria and reported on the views of 4,896 participants. The literature demonstrates strong interest in psychiatric genetic testing of adults as well as children, whereas attitudes toward prenatal testing were much less positive. Predictors of interest in testing, as well as perceived advantages and disadvantages were identified. Very few studies are available on anticipated and actual reactions to receiving results. Studies show that the majority of participants feel that having a genetic explanation would alleviate some of the stigma associated with mental illness. This review shows that interest in, and predictors of attitudes toward, psychiatric genetic testing are well researched, but the extent to which attitudes will translate into actual testing uptake is unknown. Future research also needs to assess the actual behavioral and psychological impact of genetic testing.
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Affiliation(s)
- Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Xin Y Guo
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Sophie Putt
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Janice M Fullerton
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, UNSW, Sydney, Australia
| | - Peter R Schofield
- Neuroscience Research Australia, Sydney, Australia.,School of Medical Sciences, UNSW, Sydney, Australia
| | - Philip B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, Prince of Wales Hospital, Sydney, Australia
| | - Tatiane Yanes
- Psychosocial Research Group, Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
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14
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Austin JC. Evidence-Based Genetic Counseling for Psychiatric Disorders: A Road Map. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036608. [PMID: 31501264 DOI: 10.1101/cshperspect.a036608] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Jehannine C Austin
- Departments of Psychiatry and Medical Genetics, University of British Columbia, Vancouver, British Columbia V5Z 4H4, Canada.,BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia V6Z 2A9, Canada
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15
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Gerrard S, Inglis A, Morris E, Austin J. Relationships between patient- and session-related variables and outcomes of psychiatric genetic counseling. Eur J Hum Genet 2020; 28:907-914. [PMID: 32066934 DOI: 10.1038/s41431-020-0592-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/09/2020] [Accepted: 01/22/2020] [Indexed: 11/09/2022] Open
Abstract
Little data currently exist regarding whether and how different characteristics of a patient and session influence outcomes of genetic counseling (GC). We conducted an exploratory retrospective chart review of data from a specialist psychiatric GC clinic (where patients complete the Genetic Counseling Outcome Scale (GCOS) as part of routine care before and after GC). We used ANOVA and linear regression to analyze GCOS change scores in relation to twelve patient/session-related variables. Three hundred and seven charts were included in analyses. Overall, GCOS scores increased significantly after GC, with large effect size (p < 0.0005, d = 1.10), and significant increases in all GCOS subdomains except adaptation. Significant associations with GCOS change score were identified for three variables: mode of delivery of GC (in-person/telephone/telehealth, p = 0.048, η2 = 0.020), primary indication for the appointment (understanding recurrence risk versus other primary indications, p = 0.001, η2 = 0.037), and baseline GCOS score (p < 0.000, R = 0.353). Our data showing that those with low baseline GCOS scores benefit most from GC could be used to explore the possibility of triaging those referred for GC based on this variable, and/or to identify individuals to refer to GC.
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Affiliation(s)
- Sarah Gerrard
- Joan H. Marks Graduate Program in Human Genetics, Sarah Lawrence College, Bronxville, NY, USA
| | - Angela Inglis
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Emily Morris
- Department of Psychiatry, University of British Columbia, Vancouver, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, Vancouver, Canada. .,Department of Medical Genetics, University of British Columbia, Vancouver, Canada.
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16
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Moldovan R, McGhee KA, Coviello D, Hamang A, Inglis A, Ingvoldstad Malmgren C, Johansson-Soller M, Laurino M, Meiser B, Murphy L, Paneque M, Papsuev O, Pawlak J, Rovira Moreno E, Serra-Juhe C, Shkedi-Rafid S, Laing N, Voelckel MA, Watson M, Austin JC. Psychiatric genetic counseling: A mapping exercise. Am J Med Genet B Neuropsychiatr Genet 2019; 180:523-532. [PMID: 31222934 DOI: 10.1002/ajmg.b.32735] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 03/12/2019] [Accepted: 04/19/2019] [Indexed: 11/08/2022]
Abstract
Psychiatric genetic counseling (PGC) is gradually developing globally, with countries in various stages of development. In some, PGC is established as a service or as part of research projects while in others, it is just emerging as a concept. In this article, we describe the current global landscape of this genetic counseling specialty and this field's professional development. Drawing on information provided by expert representatives from 16 countries, we highlight the following: (a) current understanding of PGC; (b) availability of services for patients; (c) availability of training; (d) healthcare system disparities and cultural differences impacting practice; and (e) anticipated challenges going forward.
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Affiliation(s)
- Ramona Moldovan
- Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania.,Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, United Kingdom.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Kevin A McGhee
- Faculty of Science and Technology, Bournemouth University, Poole, United Kingdom
| | - Domenico Coviello
- IRCCS Istituto Giannina Gaslini, Research Institute and Children Hospital, Genova, Italy
| | - Anniken Hamang
- Department of Medical Genetics, St. Olavs Hospital, Trondheim University Hospital
| | - Angela Inglis
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotta Ingvoldstad Malmgren
- Department of Public Health and Caring Science, Uppsala University, Uppsala, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Mercy Laurino
- College of Medicine, Department of Pediatrics, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines
| | - Bettina Meiser
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Lauren Murphy
- University of Texas Genetic Counseling Program, UT MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Milena Paneque
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,CGPP - Centre for Predictive and Preventive Genetics, Institute for Molecular and Cell Biology (IBMC), Universidade do Porto, Porto, Portugal
| | - Oleg Papsuev
- Moscow Research Institute of Psychiatry, Moscow, Russia
| | - Joanna Pawlak
- Department of Psychiatric Genetics, Department of Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Eulàlia Rovira Moreno
- Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain.,Department of Clinical and Molecular Genetics, Hospital Vall d'Hebron, Barcelona, Spain
| | - Clara Serra-Juhe
- Department of Clinical and Molecular Genetics, Hospital Vall d'Hebron, Barcelona, Spain.,Medicine Genetics, VHIR, Barcelona, Spain
| | - Shiri Shkedi-Rafid
- Department of Genetics and Metabolic Diseases, Hadassah Medical Center, The Faculty of Medicine, The Hebrew University, Jerusalem
| | - Nakita Laing
- Division of Human Genetics, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | - Melanie Watson
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Princess Anne Hospital, Southampton, United Kingdom
| | - Jehannine C Austin
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
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17
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Affiliation(s)
- Rachel Horton
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Gillian Crawford
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, UK
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | | | - Angela Fenwick
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, UK
| | | | - Anneke Lucassen
- Clinical Ethics and Law at Southampton (CELS), Faculty of Medicine, University of Southampton, UK
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18
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Kostick K, Pereira S, Brannan C, Torgerson L, Lázaro-Muñoz G. Psychiatric genomics researchers' perspectives on best practices for returning results to individual participants. Genet Med 2019; 22:345-352. [PMID: 31477844 PMCID: PMC7000323 DOI: 10.1038/s41436-019-0642-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/13/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Large-scale array-based and sequencing studies have advanced our understanding of the genetic architecture of psychiatric disorders, but also increased the potential to generate an exponentially larger amount of clinically relevant findings. As genomic testing becomes more widespread in psychiatry research, urgency grows to establish best practices for offering return of results (RoR) to individuals at risk or diagnosed with a psychiatric disorder. Methods We interviewed an international sample (n = 39) of psychiatric genetics researchers to examine conceptualizations of “best practices” for RoR to individual research participants. Results While the vast majority of researchers do not offer RoR, most believed medically actionable findings (85%) and clinically valid but non–medically actionable findings (54%) should be offered. Researchers identified three main areas for improvement: interfacing with individual participants; interdisciplinary training, guidance, and integration; and quality planning and resource allocation for returning results. Conclusion There are significant gaps between researchers’ visions for “best” versus “actual” RoR practices. While researchers call for participant-centered practices, including consent practices that consider any special needs of participants with psychiatric disorders, return of individually meaningful results, and effective follow-up and provisions for treatment, the current reality is that consent and RoR practices lack standardized and evidence-based norms.
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Affiliation(s)
- Kristin Kostick
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Stacey Pereira
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Cody Brannan
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Laura Torgerson
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, Houston, TX, USA.
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19
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Semaka A, Austin J. Patient perspectives on the process and outcomes of psychiatric genetic counseling:
An “Empowering Encounter
”. J Genet Couns 2019; 28:856-868. [DOI: 10.1002/jgc4.1128] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 03/21/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Alicia Semaka
- Department of Psychiatry University of British Columbia Vancouver, BC CANADA
| | - Jehannine Austin
- Department of Psychiatry University of British Columbia Vancouver, BC CANADA
- Department of Medical Genetics University of British Columbia Vancouver, BC CANADA
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20
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Abstract
Anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) are heritable conditions that are influenced by both genetic and environmental factors. Recent genome-wide association studies (GWAS) of AN have identified specific genetic loci implicated in AN, and genetic correlations have implicated both psychiatric and metabolic factors in its origin. No GWAS have been performed for BN or BED. Genetic counseling is an important tool and can aid families and patients in understanding risk for these illnesses.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, UNC Chapel Hill, University of North Carolina, CB 7160, Chapel Hill, NC 27599, USA; Department of Nutrition, University of North Carolina, CB 7400, Chapel Hill, NC 27599, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, SE-171 77, Stockholm, Sweden.
| | - Lauren Blake
- Department of Human Genetics, University of Chicago, Cummings Life Science Center, 920 East 58th Street, Chicago, IL 60637, USA
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, Translational Lab Building Room a3-112 - 3rd Floor, 938 West 28th Avenue, Vancouver, British Columbia V5Z 4H4, Canada; Department of Medical Genetics, University of British Columbia, Translational Lab Building Room a3-112 - 3rd Floor, 938 West 28th Avenue, Vancouver, British Columbia V5Z 4H4, Canada
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21
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High-risk women's risk perception after receiving personalized polygenic breast cancer risk information. J Community Genet 2018; 10:197-206. [PMID: 30097836 DOI: 10.1007/s12687-018-0378-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/05/2018] [Indexed: 12/25/2022] Open
Abstract
Evidence is accumulating of the clinical utility of single nucleotide polymorphisms to effectively stratify risk of breast cancer. Yet for this personalized polygenic information to be translated to clinical practice, consideration is needed about how this personalized risk information should be communicated and the impact on risk perception. This study examined the psychosocial implications and the impact on risk perception of communicating personalized polygenic breast cancer risk to high-risk women. High-risk women with a personal history of breast cancer and an uninformative BRCA1/2 result were genotyped in the Variants in Practice study for 22 breast cancer single nucleotide polymorphisms. Participants in the highest quartile of polygenic breast cancer risk were invited to receive their individual research results. Two personalized visual risk communication tools were used to facilitate communication of the polygenic information. Participants subsequently undertook a semi-structured interview examining their experience of receiving their polygenic breast cancer risk and their breast cancer risk perception. Thirty-nine women opted to receive their results and were interviewed. The women described the risk communication tools as helpful as the tool enabled comparison of their personalized breast cancer risk to the general population. Participants incorporated the polygenic risk information into their breast cancer risk perception, which for some reawakened feelings of being at risk years after an uninformative BRCA1/2 result. However, few reported any detrimental emotional impact. The delivery of personalized polygenic breast cancer risk to high-risk women informed and modified their breast cancer risk perception with little emotional impact.
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22
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Morris E, Hippman C, Murray G, Michalak EE, Boyd JE, Livingston J, Inglis A, Carrion P, Austin J. Self-Stigma in Relatives of people with Mental Illness scale: development and validation. Br J Psychiatry 2018; 212:169-174. [PMID: 29436312 DOI: 10.1192/bjp.2017.23] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Serious mental illness (SMI) is profoundly stigmatised, such that there is even an impact on relatives of people with SMI. Aims To develop and validate a scale to comprehensively measure self-stigma among first-degree relatives of individuals with SMI. METHOD We conducted group interviews focusing on self-stigma with first-degree relatives (n = 20) of people with SMI, from which 74 representative quotations were reframed as Likert-type items. Cognitive interviews with relatives (n = 11) identified 30 items for the Self-Stigma in Relatives of people with Mental Illness (SSRMI) scale. Relatives (n = 195) completed the scale twice, a month apart, together with four external correlate scales. RESULTS The 30-item SSRMI was reliable, with scores stable over time. Its single-factor structure allowed generation of a 10-item version. Construct validity of 30- and 10-item versions was supported by expected relationships with external correlates. CONCLUSIONS Both versions of the SSRMI scale are valid and reliable instruments appropriate for use in clinical and research contexts. Declaration of interest None.
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Affiliation(s)
- E Morris
- Department of Psychiatry,University of British Columbia,Vancouver, BC,Canada
| | - C Hippman
- Women's Health Research Institute and Department of Psychiatry,University of British Columbia,Vancouver, BC,Canada
| | - G Murray
- Swinburne University of Technology,Centre for Mental Health,Melbourne,Australia
| | - E E Michalak
- Department of Psychiatry,University of British Columbia,Vancouver, BC,Canada
| | - J E Boyd
- San Francisco VA Health Care System and University of California,San Francisco, CA,USA
| | - J Livingston
- Department of Criminology,Saint Mary's University,Halifax, NS,Canada
| | - A Inglis
- Department of Psychiatry and Department of Medical Genetics,University of British Columbia,Vancouver, BC,Canada
| | - P Carrion
- Department of Psychiatry,University of British Columbia,Vancouver, BC,Canada
| | - J Austin
- Department of Psychiatry and Department of Medical Genetics,University of British Columbia,Vancouver, BC,Canada
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23
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Roberts LW, Kim JP. Receptiveness to participation in genetic research: A pilot study comparing views of people with depression, diabetes, or no illness. J Psychiatr Res 2017; 94:156-162. [PMID: 28719815 PMCID: PMC5621512 DOI: 10.1016/j.jpsychires.2017.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Genetic research in human health relies on the participation of individuals with or at-risk for different types of diseases, including health conditions that may be stigmatized, such as mental illnesses. This preliminary study examines the differences in attitudes toward participation in genetic research among individuals with a psychiatric disorder, individuals with a physical disorder, and individuals with no known illness. METHODS Seventy-nine individuals with a history of diabetes or depression, or no known illness, underwent a simulated consent process for a hypothetical genetic research study. They were then surveyed about their willingness to participate in the hypothetical study and their attitudes about future and family participation in genetic research. RESULTS Participants with and without a history of depression ranked participating in genetic and medical research as very important and indicated that they were likely to participate in the hypothetical genetics study. Expressed willingness to participate was generally stable and consistent with future willingness. Individuals less strongly endorsed willingness to ask family members to participate in genetic research. CONCLUSION Individuals with and without a history of mental illness viewed genetic and medical research favorably and expressed willingness to participate in real-time and in the future. Informed consent processes ideally include an exploration of influences upon volunteers' enrollment decisions. Additional empirical study of influences upon genetic research participation is important to ensure that volunteers' rights are respected and that conditions that greatly affect the health of the public are not neglected scientifically.
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Affiliation(s)
- Laura Weiss Roberts
- Stanford University, School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd., Stanford, CA 94304, United States.
| | - Jane Paik Kim
- Stanford University, School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd., Stanford, CA 94304
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24
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Yanes T, Meiser B, Young MA, Kaur R, Mitchell G, Barlow-Stewart K, Roscioli T, Halliday J, James P. Psychosocial and behavioral impact of breast cancer risk assessed by testing for common risk variants: protocol of a prospective study. BMC Cancer 2017; 17:491. [PMID: 28720130 PMCID: PMC5516374 DOI: 10.1186/s12885-017-3485-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 07/13/2017] [Indexed: 01/02/2023] Open
Abstract
Background The ‘common variant, common disease’ model predicts that a significant component of hereditary breast cancer unexplained by pathogenic variants in moderate or high-penetrance genes is due to the cumulative effect of common risk variants in DNA (polygenic risk). Assessing a woman’s breast cancer risk by testing for common risk variants can provide useful information for women who would otherwise receive uninformative results by traditional monogenic testing. Despite increasing support for the utility of common risk variants in hereditary breast cancer, research findings have not yet been integrated into clinical practice. Translational research is therefore critical to ensure results are effectively communicated, and that women do not experience undue adverse psychological outcomes. Methods In this prospective study, 400 women with a personal and/or high risk family history of breast cancer will be recruited from six familial cancer centers (FCCs) in Australia. Eligible women will be invited to attend a FCC and receive their personal polygenic risk result for breast cancer. Genetic health professionals participating in the study will receive training on the return of polygenic risk information and a training manual and visual aids will be developed to facilitate patient communication. Participants will complete up to three self-administered questionnaires over a 12-months period to assess the short-and long-term psychological and behavioral outcomes of receiving or not receiving their personal polygenic risk result. Discussion This is the world’s first study to assess the psychological and behavioral impact of offering polygenic risk information to women from families at high risk of breast cancer. Findings from this research will provide the basis for the development of a new service model to provide polygenic risk information in familial cancer clinics. Trial registration The study was retrospectively registered on 27th April 2017 with the Australian and New Zealand Clinical Trials Group (Registration no: ACTRN12617000594325; clinical trial URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372743). Electronic supplementary material The online version of this article (doi:10.1186/s12885-017-3485-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tatiane Yanes
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia. .,School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Bettina Meiser
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Rajneesh Kaur
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Gillian Mitchell
- Familial Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Kristine Barlow-Stewart
- Northern Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, 2065, Australia
| | - Tony Roscioli
- Department of Medical Genetics, Sydney Children's Hospital, Sydney, Australia
| | - Jane Halliday
- Public Health Genetics, Murdoch Children's Research Institute, Melbourne, VIC, 3052, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, 3052, Australia
| | - Paul James
- Familial Cancer Service, Peter MacCallum Cancer Centre, Melbourne, VIC, 3000, Australia
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25
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Moldovan R, Pintea S, Austin J. The Efficacy of Genetic Counseling for Psychiatric Disorders: a Meta-Analysis. J Genet Couns 2017; 26:1341-1347. [DOI: 10.1007/s10897-017-0113-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 05/18/2017] [Indexed: 12/27/2022]
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26
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Genetic Counseling for Alcohol Addiction: Assessing Perceptions and Potential Utility in Individuals with Lived Experience and Their Family Members. J Genet Couns 2017; 26:963-970. [PMID: 28176155 DOI: 10.1007/s10897-017-0075-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/18/2017] [Indexed: 02/04/2023]
Abstract
Though addictions to substances including alcohol are highly heritable, there have been no studies regarding the possible applicability of genetic counseling to this set of conditions. Adults (≥18 years old) with a personal and/or family history of alcohol addiction were recruited to participate in an online survey-based study comprising 43 questions about beliefs/concern about recurrence risk and etiology of alcohol addiction and its impact on childbearing decisions, and perceptions of potential utility of genetic counseling for alcohol addiction. We applied primarily descriptive statistics, but also tested the hypotheses that perceiving genetic counseling to be useful would be associated with: 1) increasing importance attributed to genetics in the etiology of alcohol addiction, and 2) greater concern about recurrence of alcohol addiction (in self and/or children). Overall, the 113 participants recognized the multifactorial nature of alcohol addiction but reported a wide range of estimated recurrence risks for first-degree relatives. Overall, 62% perceived genetic counseling for alcohol addiction to be potentially beneficial. Participants were more likely to perceive a benefit from genetic counseling if they were concerned about recurrence for themselves (p = .021) or perceived genetics to be etiologically important in alcohol addiction (p = .024). Future studies are warranted to evaluate the outcomes of genetic counseling for addictions with respect to patient understanding, lifestyle modifications and psychological adaptation.
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27
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Madlensky L, Trepanier AM, Cragun D, Lerner B, Shannon KM, Zierhut H. A Rapid Systematic Review of Outcomes Studies in Genetic Counseling. J Genet Couns 2017; 26:361-378. [PMID: 28168332 DOI: 10.1007/s10897-017-0067-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
As healthcare reimbursement is increasingly tied to value-of-service, it is critical for the genetic counselor (GC) profession to demonstrate the value added by GCs through outcomes research. We conducted a rapid systematic literature review to identify outcomes of genetic counseling. Web of Science (including PubMed) and CINAHL databases were systematically searched to identify articles meeting the following criteria: 1) measures were assessed before and after genetic counseling (pre-post design) or comparisons were made between a GC group vs. a non-GC group (comparative cohort design); 2) genetic counseling outcomes could be assessed independently of genetic testing outcomes, and 3) genetic counseling was conducted by masters-level genetic counselors, or non-physician providers. Twenty-three papers met the inclusion criteria. The majority of studies were in the cancer genetic setting and the most commonly measured outcomes included knowledge, anxiety or distress, satisfaction, perceived risk, genetic testing (intentions or receipt), health behaviors, and decisional conflict. Results suggest that genetic counseling can lead to increased knowledge, perceived personal control, positive health behaviors, and improved risk perception accuracy as well as decreases in anxiety, cancer-related worry, and decisional conflict. However, further studies are needed to evaluate a wider array of outcomes in more diverse genetic counseling settings.
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Affiliation(s)
- Lisa Madlensky
- Moores UCSD Cancer Center, University of California San Diego, 3855 Health Sciences Drive, La Jolla, CA, 92091-0901, USA.
| | - Angela M Trepanier
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
| | - Deborah Cragun
- Department of Global Health, University of South Florida, Tampa, FL, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Barbara Lerner
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
| | | | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota - Twin Cities, Minneapolis, MN, USA
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Lent MR, Hoffman SN, Kirchner HL, Urosevich TG, Boscarino JJ, Boscarino JA. Attitudes about Future Genetic Testing for Posttraumatic Stress Disorder and Addiction among Community-Based Veterans. Front Psychiatry 2017; 8:76. [PMID: 28555114 PMCID: PMC5430945 DOI: 10.3389/fpsyt.2017.00076] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/20/2017] [Indexed: 01/16/2023] Open
Abstract
This study explored attitudes toward hypothetical genetic testing for posttraumatic stress disorder (PTSD) and addiction among veterans. We surveyed a random sample of community-based veterans (n = 700) by telephone. One year later, we asked the veterans to provide a DNA sample for analysis and 41.9% of them returned the DNA samples. Overall, most veterans were not interested in genetic testing neither for PTSD (61.7%) nor for addiction (68.7%). However, bivariate analyses suggested there was an association between having the condition of interest and the likelihood of genetic testing on a 5-point scale (p < 0.001 for PTSD; p = 0.001 for alcohol dependence). While ordinal regressions confirmed these associations, the models with the best statistical fit were bivariate models of whether the veteran would likely test or not. Using logistic regressions, significant predictors for PTSD testing were receiving recent mental health treatment, history of a concussion, younger age, having PTSD, having alcohol dependence, currently taking opioids for pain, and returning the DNA sample during the follow-up. For addiction testing, significant predictors were history of concussion, younger age, psychotropic medication use, having alcohol dependence, and currently taking opioids for pain. Altogether, 25.9% of veterans reported that they would have liked to have known their genetic results before deployment, 15.6% reported after deployment, and 58.6% reported they did not want to know neither before nor after deployment. As advancements in genetic testing continue to evolve, our study suggests that consumer attitudes toward genetic testing for mental disorders are complex and better understanding of these attitudes and beliefs will be crucial to successfully promote utilization.
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Affiliation(s)
- Michelle R Lent
- Department of Epidemiology and Health Services Research, Geisinger Clinic, Danville, PA, USA
| | | | - H Lester Kirchner
- Department of Biomedical and Translational Informatics, Geisinger Clinic, Danville, PA, USA
| | | | | | - Joseph A Boscarino
- Department of Epidemiology and Health Services Research, Geisinger Clinic, Danville, PA, USA
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Leach E, Morris E, White HJ, Inglis A, Lehman A, Austin J. How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians' Practice. J Genet Couns 2016; 25:1235-1242. [PMID: 27185057 PMCID: PMC5173357 DOI: 10.1007/s10897-016-9961-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/15/2016] [Indexed: 11/27/2022]
Abstract
Psychiatric genetic counseling (PGC) is an emerging specialty discipline within the genetic counseling profession. A specialist PGC service was founded in 2012 in Vancouver, Canada, and though patient benefits have been demonstrated, many physicians do not regularly refer patients to the service despite awareness of its availability. We conducted a qualitative study involving semi-structured telephone interviews with Vancouver-based physicians who were aware of the PGC service to explore this phenomenon. Interviews were audio-recorded, transcribed verbatim, coded, and analysed for emergent themes. Consistent with a grounded theory approach, constant comparison was employed throughout data collection and analysis. Analyses of interviews conducted with 12 physicians revealed that referral practices were informed by perceptions about the purpose of PGC and interpretation of patient cues. Physicians perceived PGC as an information-focused intervention, and considered referral when patients explicitly expressed desire for information about recurrence risk or etiology that they felt unable to adequately address themselves. Even when physicians identified psychotherapeutic benefits of PGC, patient needs of this nature were not perceived as cues prompting referral to PGC. These data suggest that further work is necessary to position PGC in physicians' minds as a service that could potentially benefit most individuals with psychiatric disorders and their families, and that it encompasses more than information provision. It is important to increase physicians' awareness of the complementary role that genetic counselors can play to that of the physician in providing psychotherapeutically oriented counselling about illness etiology.
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Affiliation(s)
- Emma Leach
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Emily Morris
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
- Department of Psychiatry, University of British Columbia, Rm A3-112, CFRI Translational Lab Building, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
| | - Hannah J White
- California State University, Stanislaus, Turlock, CA, USA
| | - Angela Inglis
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
- Department of Psychiatry, University of British Columbia, Rm A3-112, CFRI Translational Lab Building, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
| | - Anna Lehman
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada.
- Department of Psychiatry, University of British Columbia, Rm A3-112, CFRI Translational Lab Building, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
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Andrighetti H, Semaka A, Stewart SE, Shuman C, Hayeems R, Austin J. Obsessive-Compulsive Disorder: The Process of Parental Adaptation and Implications for Genetic Counseling. J Genet Couns 2016; 25:912-22. [PMID: 26639756 PMCID: PMC4942265 DOI: 10.1007/s10897-015-9914-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/11/2015] [Indexed: 01/07/2023]
Abstract
Obsessive-compulsive disorder (OCD) has primarily pediatric onset and well-documented unique impacts on family functioning. Limited research has assessed the understanding that parents of children with OCD have of the etiology of the condition, and there are no data regarding potential applications of genetic counseling for this population. We recruited 13 parents of 13 children diagnosed with OCD from the OCD Registry at British Columbia Children's Hospital, and conducted qualitative semi-structured telephone interviews to explore participants' experiences with their child's OCD, causal attributions of OCD, and perceptions of two genetic counseling vignettes. Interviews were audio-recorded, transcribed, and analyzed using elements of grounded theory qualitative methodology. Analysis revealed key components and contextual elements of the process through which parents adapt to their child's OCD. This adaptation process involved conceptualizing the meaning of OCD, navigating its impact on family dynamics, and developing effective illness management strategies. Adaptation took place against a backdrop of stigmatization and was shaped by participants' family history of mental illness and their child's specific manifestations of OCD. Parents perceived genetic counseling, as described in the vignettes, as being empowering, alleviating guilt and blame, and positively impacting treatment orientation. These data provide insight into the process of parental adaptation to pediatric OCD, and suggest that genetic counseling services for families affected by OCD may help facilitate adaptation to this illness.
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Affiliation(s)
- Heather Andrighetti
- Department of Psychiatry, University of British Columbia, 3rd floor, A3-112, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
| | - Alicia Semaka
- Department of Psychiatry, University of British Columbia, 3rd floor, A3-112, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
| | - S Evelyn Stewart
- Department of Psychiatry, University of British Columbia, 3rd floor, A3-112, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
| | - Cheryl Shuman
- Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robin Hayeems
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, 3rd floor, A3-112, 938 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada.
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Genetic Counselling for Psychiatric Disorders: Accounts of Psychiatric Health Professionals in the United Kingdom. J Genet Couns 2016; 25:1243-1255. [PMID: 27453210 PMCID: PMC5114337 DOI: 10.1007/s10897-016-9990-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 04/25/2016] [Indexed: 10/26/2022]
Abstract
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.
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Hippman C, Ringrose A, Inglis A, Cheek J, Albert AYK, Remick R, Honer WG, Austin JC. A pilot randomized clinical trial evaluating the impact of genetic counseling for serious mental illnesses. J Clin Psychiatry 2016; 77:e190-8. [PMID: 26930535 PMCID: PMC4864025 DOI: 10.4088/jcp.14m09710] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 04/08/2015] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The serious mental illnesses schizophrenia, schizoaffective disorder, and bipolar disorder are complex conditions affecting 1% to 4% of the population. Individuals with serious mental illnesses express interest in genetic counseling, an intervention showing promise for increasing patient knowledge and adaptation. This trial aimed to evaluate the effects of genetic counseling for people with serious mental illnesses as compared to an educational intervention or wait list. METHOD A pilot 3-arm (each n = 40; genetic counseling, a control intervention involving an educational booklet, or wait list), parallel-group, randomized clinical trial was conducted from September 2008 through November 2011 in Vancouver, Canada. Participants with schizophrenia, bipolar disorder, or schizoaffective disorder (DSM-IV) completed outcome measures assessing knowledge, risk perception, internalized stigma, and perceived control over illness at baseline and 1-month follow-up. The Brief Symptom Inventory was administered to control for current symptoms. Analyses included linear mixed-effects models and χ(2) tests. RESULTS Knowledge increased for genetic counseling/educational booklet compared to wait list at follow-up (LRT1 = 19.33, Holm-adjusted P = .0003, R(2)LMM(m) = 0.17). Risk perception accuracy increased at follow-up for genetic counseling compared to wait list (Yates continuity corrected χ(2)1 = 9.1, Bonferroni P = .003) and educational booklet (Yates continuity corrected χ(2)1 = 8.2, Bonferroni P = .004). There were no significant differences between groups for stigma or perceived control scores. CONCLUSIONS Genetic counseling and the educational booklet improved knowledge, and genetic counseling, but not the educational booklet, improved risk perception accuracy for this population. The impact of genetic counseling on internalized stigma and perceived control is worth further investigation. Genetic counseling should be considered for patients with serious mental illnesses. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00713804.
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Affiliation(s)
- Catriona Hippman
- University of British Columbia, Department of Psychiatry, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada
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Ryan J, Virani A, Austin JC. Ethical issues associated with genetic counseling in the context of adolescent psychiatry. Appl Transl Genom 2015; 5:23-9. [PMID: 26937355 PMCID: PMC4745399 DOI: 10.1016/j.atg.2015.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/04/2015] [Accepted: 06/05/2015] [Indexed: 01/19/2023]
Abstract
Genetic counseling is a well-established healthcare discipline that provides individuals and families with health information about disorders that have a genetic component in a supportive counseling encounter. It has recently been applied in the context of psychiatric disorders (like schizophrenia, bipolar disorder, schizoaffective disorder, obsessive compulsive disorder, depression and anxiety) that typically appear sometime during later childhood through to early adulthood. Psychiatric genetic counseling is emerging as an important service that fills a growing need to reframe understandings of the causes of mental health disorders. In this review, we will define psychiatric genetic counseling, and address important ethical concerns (we will particularly give attention to the principles of autonomy, beneficence, non-maleficence and justice) that must be considered in the context of its application in adolescent psychiatry, whilst integrating evidence regarding patient outcomes from the literature. We discuss the developing capacity and autonomy of adolescents as an essential and dynamic component of genetic counseling provision in this population and discuss how traditional viewpoints regarding beneficence and non-maleficence should be considered in the unique situation of adolescents with, or at risk for, psychiatric conditions. We argue that thoughtful and tailored counseling in this setting can be done in a manner that addresses the important health needs of this population while respecting the core principles of biomedical ethics, including the ethic of care.
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Affiliation(s)
- Jane Ryan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Alice Virani
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
- Centre for Applied Ethics, University of British Columbia, Vancouver, Canada
| | - Jehannine C. Austin
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
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Baughman ST, Morris E, Jensen K, Austin J. Disclosure of psychiatric manifestations of 22q11.2 deletion syndrome in medical genetics: A 12-year retrospective chart review. Am J Med Genet A 2015; 167A:2350-6. [PMID: 26033850 DOI: 10.1002/ajmg.a.37190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/15/2015] [Indexed: 01/16/2023]
Abstract
Individuals with 22q11.2 deletion syndrome (22qDS) have increased risk for psychiatric disorders. However, while medical geneticists self-report discussing psychiatric features of 22qDS with families (though often only when the child is older), most parents of children with 22qDS report receiving information about the psychiatric manifestations of 22qDS from non-medical sources. In an attempt to reconcile these previous findings, we sought to objectively determine the frequency with which medical geneticists discuss the potential psychiatric manifestations of 22qDS: (i) in letters to referring physicians and (ii) with families, and to explore plans for follow-up. We abstracted data from charts of patients with 22qDS who were referred to a single medical genetics center between January 1, 2000 and December 31, 2012. Psychiatric disorders were discussed in consult letters to referring physicians for n = 57 (46%) of the 125 patients who met inclusion criteria-making them less frequently discussed than all other features of 22qDS. Despite exhaustive review of charts, the content of discussions with families was typically unclear. Follow-up in medical genetics was suggested for 50 people but only 18 (36%) of these patients returned. Disclosure of psychiatric features of 22qDS to families is necessary so that psychiatric disorders can be identified in time for early intervention to be implemented to achieve better prognosis for those affected. These empiric data offer some explanation as to why psychiatric services are underused by individuals with 22qDS.
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Affiliation(s)
- Serena Talcott Baughman
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Morris
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly Jensen
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jehannine Austin
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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Thompson C, Steven P Hamilton, Catriona Hippman. Psychiatrist attitudes towards pharmacogenetic testing, direct-to-consumer genetic testing, and integrating genetic counseling into psychiatric patient care. Psychiatry Res 2015; 226:68-72. [PMID: 25618469 DOI: 10.1016/j.psychres.2014.11.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 11/02/2014] [Accepted: 11/22/2014] [Indexed: 11/29/2022]
Abstract
Psychiatric treatment has not historically included genetic counseling or genetic testing. It has been shown that psychiatric patients and their families benefit from genetic counseling and pharmacogenetic testing for pharmacological treatment. To date, no study has investigated psychiatrists' attitudes towards incorporating pharmacogenetic testing and genetic counseling into patient treatment. This study employed a five item survey to solicit the opinions of psychiatrists on the benefit of pharmacogenetic data, direct to consumer (DTC) genetic testing, and genetic counseling. A total of 113 psychiatrists responded to the surveys. The vast majority (94.6%) indicated that genetic data would be useful in making pharmaceutical decisions, and 86% felt that pharmacogenetic testing would become standard of care. Attitudes were split towards the benefit of direct to consumer genetic testing; 55.8% of respondents would refer a patient for DTC genetic testing that might help with treatment decisions. The majority (72.6%) believed that it would be beneficial to include genetic counselors in psychiatric patient care. The results of our study suggest there is potential for collaboration between psychiatrists and genetic counselors to enhance patient care.
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Affiliation(s)
- Carmela Thompson
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA.
| | - Steven P Hamilton
- Department of Psychiatry, Kaiser Permanente Medical Center, San Francisco, CA, USA
| | - Catriona Hippman
- Women's Health Research Institute, BC Women's Hospital and Health Centre; Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Inglis A, Koehn D, McGillivray B, Stewart SE, Austin J. Evaluating a unique, specialist psychiatric genetic counseling clinic: uptake and impact. Clin Genet 2015; 87:218-24. [PMID: 24773225 PMCID: PMC4318688 DOI: 10.1111/cge.12415] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/24/2014] [Accepted: 04/25/2014] [Indexed: 01/20/2023]
Abstract
People with psychiatric disorders and their family members have expressed interest in receiving genetic counseling (GC). In February 2012, we opened the first (to our knowledge) specialist psychiatric GC clinic of its kind, for individuals with non-syndromic psychiatric disorders and their families. Prior to GC and at a standard 1-month follow-up session, clinical assessment tools are completed, specifically, the GC outcomes scale (GCOS, which measures empowerment, completed by all clients) and the Illness Management Self Efficacy scale (IMSES, completed by those with mental illness). Consecutive English-speaking clients attending the clinic between 1 February 2012 and 31 January 2013 who were capable of consenting were asked for permission to use their de-identified clinical data for research purposes. Descriptive analyses were conducted to ascertain demographic details of attendees, and paired sample t-tests were conducted to assess changes in GCOS and IMSES scores from pre- to post-GC. Of 143 clients, seven were unable to consent, and 75/136 (55.1%) consented. Most were female (85.3%), self-referred (76%), and had personal experience of mental illness (65.3%). Mean GCOS and IMSES scores increased significantly after GC (p < 0.0001 and p = 0.011, respectively). In a naturalistic setting, GC increases empowerment and self-efficacy in this population.
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Affiliation(s)
- Angela Inglis
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - David Koehn
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - Barbara McGillivray
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| | - S. Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Jehannine Austin
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
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McAllister M, Dearing A. Patient reported outcomes and patient empowerment in clinical genetics services. Clin Genet 2014; 88:114-21. [PMID: 25307491 DOI: 10.1111/cge.12520] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/06/2014] [Accepted: 10/06/2014] [Indexed: 12/20/2022]
Abstract
Evaluation of clinical genetics services (CGS), including genetic counseling and genetic testing, has been problematic. Patient mortality and morbidity are unlikely to be directly improved by interventions offered in CGS. Patient-reported outcomes (PROs) are not routinely measured in CGS evaluation, but this may change as patient-reported outcome measures (PROMs) become a key part of how healthcare services are managed and funded across the world. However, there is no clear consensus about which PROMs are most useful for CGS evaluation. This review summarizes the published research on how PROs from CGS have been measured and how patients may benefit from using those services, with a focus on patient empowerment. Many patient benefits (PROs) identified repeatedly in the research literature can be re-interpreted within a patient empowerment framework. Other important PROs identified include family functioning, social functioning, altruism, sense of purpose, enabling development of future research and treatment/participating in research. Well-validated measures are available to capture (dimensions of) patient empowerment. Although generic measures of family functioning are available, suitable measures capturing social functioning, development of future treatments, and altruism were not identified in this review. Patient empowerment provides one useful approach to measuring PROs from CGS.
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Affiliation(s)
- M McAllister
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - A Dearing
- Institute of Cancer & Genetics, School of Medicine, Cardiff University, Cardiff, UK
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Skinner S, Guimond C, Butler R, Dwosh E, Traboulsee AL, Sadovnick AD. An Assessment of Genetic Counseling Services for Individuals with Multiple Sclerosis. J Genet Couns 2014; 24:46-57. [DOI: 10.1007/s10897-014-9735-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 06/03/2014] [Indexed: 11/28/2022]
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Costain G, Esplen MJ, Toner B, Hodgkinson KA, Bassett AS. Evaluating genetic counseling for family members of individuals with schizophrenia in the molecular age. Schizophr Bull 2014; 40:88-99. [PMID: 23104866 PMCID: PMC3885286 DOI: 10.1093/schbul/sbs124] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Myths and concerns about the extent and meaning of genetic risk in schizophrenia may contribute to significant stigma and burden for families. Genetic counseling has long been proposed to be a potentially informative and therapeutic intervention for schizophrenia. Surprisingly, however, available data are limited. We evaluated a contemporary genetic counseling protocol for use in a community mental health-care setting by non-genetics professionals. METHODS We used a pre-post study design with longitudinal follow-up to assess the impact of genetic counseling on family members of individuals with schizophrenia, where molecular testing had revealed no known clinically relevant genetic risk variant. We assessed the outcome using multiple measures, including standard items and scales used to evaluate genetic counseling for other complex diseases. RESULTS Of the 122 family members approached, 78 (63.9%) actively expressed an interest in the study. Participants (n = 52) on average overestimated the risk of familial recurrence at baseline, and demonstrated a significant improvement in this estimate postintervention (P < .0001). This change was associated with an enduring decrease in concern about recurrence (P = .0003). Significant and lasting benefits were observed in other key areas, including increased knowledge (P < .0001) and a decreased sense of stigma (P = .0047). Endorsement of the need for genetic counseling was high (96.1%). CONCLUSIONS These results provide initial evidence of the efficacy of schizophrenia genetic counseling for families, even in the absence of individually relevant genetic test results or professional genetics services. The findings support the integration of contemporary genetic counseling for families into the general management of schizophrenia in the community.
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Affiliation(s)
- Gregory Costain
- To whom correspondence should be addressed; Centre for Addiction and Mental Health, 33 Russell Street, Room 1100, Toronto, Ontario, Canada M5S 2S1; tel: +1-416-535-8501 ext. 2731, fax: +1-416-535-7199, e-mail:
| | - Mary Jane Esplen
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Behavioural Sciences and Health Research Division, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Brenda Toner
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Social Equity and Health Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kathleen A. Hodgkinson
- Clinical Epidemiology and Genetics, Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John’s, Newfoundland, Canada
| | - Anne S. Bassett
- Department of Psychiatry and Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada,To whom correspondence should be addressed; Centre for Addiction and Mental Health, 33 Russell Street, Room 1100, Toronto, Ontario, Canada M5S 2S1; tel: +1-416-535-8501 ext. 2731, fax: +1-416-535-7199, e-mail:
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Hippman C, Lohn Z, Ringrose A, Inglis A, Cheek J, Austin JC. "Nothing is absolute in life": understanding uncertainty in the context of psychiatric genetic counseling from the perspective of those with serious mental illness. J Genet Couns 2013; 22:625-32. [PMID: 23604904 DOI: 10.1007/s10897-013-9594-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 04/09/2013] [Indexed: 11/29/2022]
Abstract
No genetic tests are currently clinically available for serious mental illnesses such as schizophrenia and bipolar disorder. Rather, the full spectrum of genetic variants that confer susceptibility remain unknown, and estimates of probability of condition recurrence typically have the form of ranges rather than single absolute numbers. Genetic counselors have been shown to feel that the information that can be provided for patients with serious mental illness could be more confusing than helpful. However, how those with serious mental illness perceive this uncertainty remains unknown. So, to investigate this, individuals with serious mental illness participated in a psychiatric genetic counseling (GC) session and responded to a single open ended question about their reactions towards the uncertainty that they encountered in their GC session immediately and one month post-counseling (from which themes were identified), and completed the Genetic Counseling Satisfaction Scale immediately post-session (descriptive statistics applied). While some of the 37 participants were disappointed with the uncertainty, twice as many were unconcerned. Overall, responses from immediately and one month after GC were very similar; participants were very satisfied with, and found value in GC despite uncertainty, and four approaches to coping with uncertainty emerged. Ultimately, these findings offer insight into providing GC for those with serious mental illness, and potentially could be applied to other areas of GC where uncertainty lies, with downstream impact on GC practice and future research.
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Affiliation(s)
- Catriona Hippman
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada,
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Costain G, Bassett AS. Clinical applications of schizophrenia genetics: genetic diagnosis, risk, and counseling in the molecular era. APPLICATION OF CLINICAL GENETICS 2012; 5:1-18. [PMID: 23144566 PMCID: PMC3492098 DOI: 10.2147/tacg.s21953] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Schizophrenia is a complex neuropsychiatric disease with documented clinical and genetic heterogeneity, and evidence for neurodevelopmental origins. Driven by new genetic technologies and advances in molecular medicine, there has recently been concrete progress in understanding some of the specific genetic causes of this serious psychiatric illness. In particular, several large rare structural variants have been convincingly associated with schizophrenia, in targeted studies over two decades with respect to 22q11.2 microdeletions, and more recently in large-scale, genome-wide case-control studies. These advances promise to help many families afflicted with this disease. In this review, we critically appraise recent developments in the field of schizophrenia genetics through the lens of immediate clinical applicability. Much work remains in translating the recent surge of genetic research discoveries into the clinic. The epidemiology and basic genetic parameters (such as penetrance and expression) of most genomic disorders associated with schizophrenia are not yet well characterized. To date, 22q11.2 deletion syndrome is the only established genetic subtype of schizophrenia of proven clinical relevance. We use this well-established association as a model to chart the pathway for translating emerging genetic discoveries into clinical practice. We also propose new directions for research involving general genetic risk prediction and counseling in schizophrenia.
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Affiliation(s)
- Gregory Costain
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada ; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
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Lautenbach DM, Hiraki S, Campion MW, Austin JC. Mothers' perspectives on their child's mental illness as compared to other complex disorders in their family: insights to inform genetic counseling practice. J Genet Couns 2011; 21:564-72. [PMID: 22089936 DOI: 10.1007/s10897-011-9420-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 10/19/2011] [Indexed: 11/27/2022]
Abstract
To facilitate the development of a therapeutic alliance in genetic counseling, it is important that the counselor understands how families might perceive the condition that constitutes the reason for the referral. Through training and professional practice, genetic counselors develop a thorough understanding of families' perceptions of the conditions that are common indications for genetic counseling. But, for referral indications that are less frequent, like serious mental illnesses, genetic counselors may feel less confident in their understanding of the family's experience, or in their ability to provide psychosocial support when serious mental illness is reported in a family history. This may impede the establishment of a therapeutic alliance. As research shows that most referrals for genetic counseling related to serious mental illness are for female first-degree family members of affected individuals, we sought to explore how this group perceives serious mental illness. To provide a frame of reference with which genetic counselors may be more familiar, we explored how women perceived serious mental illness compared to other common complex disorders in their family. We conducted semi-structured interviews with women who had a child with a serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder) and a first-degree relative with another common complex disorder (diabetes, heart disease, cancer). Interviews were transcribed and subjected to thematic analysis. Saturation was reached when nine women had participated. Serious mental illness was perceived as being more severe and as having a greater impact on the family than diabetes, heart disease, or cancer. Themes identified included guilt, stigma, and loss. Some of the most important issues that contribute to mothers' perceptions that serious mental illness is more severe than other common complex disorders could be effectively addressed in genetic counseling. Developing a heightened awareness of how family members experience a relative's mental illness may help genetic counselors to be better able to provide psychosocial support to this group, whether serious mental illness constitutes the primary reason for referral or appears in the family history during counseling for a different referral reason.
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Affiliation(s)
- Denise M Lautenbach
- Masters Program in Genetic Counseling, Boston University School of Medicine, Boston, MA, USA
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