Genetic Counseling for Common Psychiatric Disorders: An Opportunity for Interdisciplinary Collaboration

Abstract

In their timely review of recent important genetic findings in psychiatric disordersspecifically, common and rare copy number variants (CNVs) in bipolar disorder, schizophrenia and autism spectrum disorders-Gershon and Alliey-Rodriguez (1) propose that these findings "must lead to profound changes" in genetic counseling and "propose that genetic counseling is more than risk prediction."The genetic counseling profession has devoted considerable attention to the process of risk communication (2) and the conceptualization of risk as a complex construct that comprises more than probability alone-for instance, by addressing how a client's context and subjective perception of the severity of a potential outcome influences perceptions of risk (3). Within this framework, the identification of CNVs that play important roles in the etiology of psychiatric disorders represents a refinement in our ability to predict probabilities of illness, rather than a major paradigm shift in the risk communication process.Similarly, psychological and psychotherapeutic dimensions to genetic counseling, such as attending to experiences of stigma, shame and guilt, have been explored in the genetic counseling literature for several decades (4). We fully agree with the authors that a "psychotherapeutic approach" would best serve patients and families seeking psychiatric genetic counseling for high-impact detectable genetic events such as CNVs, and we would add that such an approach ought to inform all genetic counseling encounters. This is consistent with a growing body of evidence from studies of genetic counseling practice indicating that attending to psychological dimensions of practice, such as the facilitation of understanding, empathic responses and lower levels of verbal dominance, are associated with more positive outcomes (5).We agree with the authors that there is a need for expert counseling for families affected by psychiatric disorders, and propose that there is much to be gained by greater collaboration between the psychiatric genetics community and the genetic counseling profession, in particular with regard to exploring how best to implement testing for CNVs in psychiatric populations in clinical practice, and how to manage the attendant ethical challenges.

Obsessive‐Compulsive Disorder: The Process of Parental Adaptation and Implications for Genetic Counseling

“…These data support collaboration between psychiatrists and genetic counselors to provide genetic counseling services for families (J. Austin, Inglis, & Hadjipavlou, 2014), which may help to facilitate the process of adaptation to OCD. Additionally, from a broader public health perspective, this model describes how a common disease can impact individuals and their families, and how genetic counseling may be able to provide them with an additional source of support.…”

How do Physicians Decide to Refer Their Patients for Psychiatric Genetic Counseling? A Qualitative Study of Physicians’ Practice

“…However, questions remain about how to integrate genomic medicine into clinical practice, such that patients reap the greatest possible benefits from increased understanding about the role of genetics in the conditions they live with or for which they are at risk. Many commentators have suggested that perhaps the optimal strategy for effective integration of genomics into all aspects of healthcare is to develop interdisciplinary collaborations between genetic counselors and physicians, including those engaged in family practice as well as specialists (Omenn, 2000;Greendale and Pyeritz, 2001;Guttmacher et al, 2001;Erskine et al, 2013;Austin et al, 2014).…”

“…Given growing evidence indicating that people with psychiatric disorders and their families would like to receive genetic counseling (DeLisi and Bertisch, 2006;Lyus, 2007;Austin and Honer, 2008;Peay et al, 2009), psychiatry is an area of practice that potentially presents an ideal scenario for fruitful interdisciplinary collaboration between physicians and genetic counselors (Thompson et al 2015). Indeed, clear benefits have been demonstrated for individuals who have received genetic counseling for psychiatric illnesses, including improved understanding of causes of mental illness, reduced concern about other relatives becoming affected, and feeling more hopeful, in control, better able to cope and help, and reduced anxiety, self-blame and guilt (Austin and Honer, 2008;Costain et al, 2012Costain et al, , 2014Inglis et al, 2014). The world's first specialist service providing psychiatric genetic counseling (PGC) service of its kind was established in 2012 in Vancouver, British Columbia to provide genetic counseling to individuals with mental illness and their family members.…”

“…The world's first specialist service providing psychiatric genetic counseling (PGC) service of its kind was established in 2012 in Vancouver, British Columbia to provide genetic counseling to individuals with mental illness and their family members. A naturalistic study of patient outcomes after being seen in the clinic showed statistically significant increases in empowerment among individuals with mental illness and their families, and increased selfefficacy among individuals with mental illness (Inglis et al, 2014).…”

“…Through a large number of presentations and grand rounds were conducted to raise awareness of the clinic among local physicians, and to highlight the service and the benefits of PGC for patients, strikingly, the large majority (76%) of patients who accessed the PGC service during its first year were self-referred (Inglis et al, 2014). This raised the question about how physicians make decisions about when to refer patients to the PGC clinic.…”