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Morris E, McGrail K, Cressman S, Stewart SE, Austin J. Assessing the impact of psychiatric genetic counseling on psychiatric hospitalizations. Clin Genet 2024; 105:630-638. [PMID: 38342854 DOI: 10.1111/cge.14493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/13/2024]
Abstract
Psychiatric genetic counseling (pGC) can improve patient empowerment and self-efficacy. We explored the relationship between pGC and psychiatric hospitalizations, for which no prior data exist. Using Population Data BC (a provincial dataset), we tested two hypotheses: (1) among patients (>18 years) with psychiatric conditions who received pGC between May 2010 and Dec 2016 (N = 387), compared with the year pre-pGC, in the year post-pGC there would be fewer (a) individuals hospitalized and (b) total hospital admissions; and (2) using a matched cohort design, compared with controls (N = 363, matched 1:4 for sex, diagnosis, time since diagnosis, region, and age, and assigned a pseudo pGC index date), the pGC cohort (N = 91) would have (a) more individuals whose number of hospitalizations decreased and (b) fewer hospitalizations post-pGC/pseudo-index. We also explored total days in hospital. Within the pGC cohort, there were fewer hospitalizations post-pGC than pre- pGC (p = 0.011, OR = 1.69), and total days in hospital decreased (1085 to 669). However, when compared to matched controls, the post-pGC/pseudo index change in hospitalizations among pGC cases was not statistically significant, even after controlling for the higher number of hospitalizations prior. pGC may lead to fewer psychiatric hospitalizations and cost savings; further studies exploring this are warranted.
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Affiliation(s)
- Emily Morris
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn McGrail
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonya Cressman
- University of British Columbia Digital Emergency Medicine, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology and Evaluation, Simon Fraser University, Burnaby, British Columbia, Canada
| | - S Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jehannine 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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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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Besterman AD. A genetics-guided approach to the clinical management of schizophrenia. Schizophr Res 2024; 267:462-469. [PMID: 37813777 DOI: 10.1016/j.schres.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023]
Abstract
Schizophrenia is a highly heritable, severe mental illness characterized by hallucinations, delusions, social withdrawal, and cognitive dysfunction present in ∼1% of populations across cultures. There have been recent major advancements in our understanding of the genetic architecture of schizophrenia. Both rare, highly penetrant genetic variants as well as common, low-penetrant genetic variants can predispose individuals to schizophrenia and can impact the way people metabolize psychoactive medications used to treat schizophrenia. However, the impact of these findings on the clinical management of schizophrenia remains limited. This review highlights the few places where genetics currently informs schizophrenia management strategies, discusses major limitations, and reviews promising areas of genetics research that are most likely to impact future schizophrenia care. Specifically, I focuss on psychiatric genetic counseling, genetic testing strategies, pharmacogenetics, polygenic risk, and genetics-guided treatment. Lastly, I emphasize important ethical considerations in the clinical use of genetics for schizophrenia management, including the exacerbation of healthcare inequalities and unintended consequences of new genetic technologies.
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Affiliation(s)
- Aaron D Besterman
- University of California San Diego, Department of Psychiatry, San Diego, CA, USA; Rady Children's Hospital San Diego, Division of Behavioral Health Services, San Diego, CA, USA; Rady Children's Institute for Genomic Medicine, San Diego, CA, USA.
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4
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Bassett AS. Clinical genetics of schizophrenia and related neuropsychiatric disorders. Psychiatry Res 2023; 319:114992. [PMID: 36463725 DOI: 10.1016/j.psychres.2022.114992] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 11/29/2022]
Abstract
Rare structural variants have turned out to be the long sought for genetic variants of (relatively) high effect size for schizophrenia. Delineating the 22q11.2 microdeletion as the first molecular subtype of schizophrenia was a milestone in schizophrenia research, foreshadowing a more general role for rare copy number variation (CNV) in schizophrenia. The 22q11.2 microdeletion has a high effect size - one in every four individuals born with this deletion develops schizophrenia - and a relatively high prevalence for a rare condition. Discovery of this human genetic high-risk model for schizophrenia has shown how genetics can change clinical management, and also provide new opportunities for animal and cellular models. Further new findings indicate a role for tandem repeat expansion, other less complex rare variants, and collective background effects of common variants in the genetics of schizophrenia. Thus, the genetic architecture of schizophrenia is taking shape, with further advances on the horizon.
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Affiliation(s)
- Anne S Bassett
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Clinical Genetics Research Program, and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, Department of Psychiatry and Division of Cardiology, Department of Medicine, and Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada.
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5
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Isbister J, Sexton A, Forrest LE, James P, Dowty J, Taylor J, Austin J, Winship I. Psychiatric genetic counseling: A survey of Australian genetic counselors' practice and attitudes. J Genet Couns 2022; 32:495-502. [PMID: 36480151 DOI: 10.1002/jgc4.1659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/04/2022] [Accepted: 11/05/2022] [Indexed: 12/14/2022]
Abstract
Genetic counseling plays a critical role in supporting individuals and their families' adaption to psychiatric conditions, addressing the multifactorial nature of these conditions in a personally meaningful and empowering way. Yet data related to the practice and attitudes of Australian genetic counselors about psychiatric genetic counseling (PGC) is limited. This survey investigated the practice of Australian genetic counselors, and their attitudes toward PGC. Genetic counselors (N = 393) were invited to participate in an anonymous online survey between March and May 2022. Forty-four genetic counselors (response rate = 11%) from Australia and New Zealand responded. No respondents practice in psychiatric genetics as their speciality area; most respondents do not see any patients where the primary indication is a personal and/or family history of psychiatric disorders (91%). Greater than half of respondents (56%) believed there was sufficient evidence to support PGC, and 64% enquire about personal and/or family history of psychiatric disorders, but only 25% provide genetic counseling on this topic. Most respondents do not feel confident providing risk assessments for psychiatric disorders (72%), while the majority expressed interest in attending specialist training (95%), and in incorporating PGC into future practice (77%). Australian genetic counselors would benefit from psychiatric genetic education and training, and establishment of specialized PGC services would address this gap in patient care, while providing opportunities for genetic counselors to gain skills and experience in PGC.
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Affiliation(s)
- Joanne Isbister
- Genomic Medicine & Familial Cancer Centre Royal Melbourne Hospital Parkville Victoria Australia
- Department of Medicine The University of Melbourne Parkville Victoria Australia
- Parkville Familial Cancer Centre, Peter McCallum Cancer Centre Melbourne Victoria Australia
| | - Adrienne Sexton
- Genomic Medicine & Familial Cancer Centre Royal Melbourne Hospital Parkville Victoria Australia
- Department of Medicine The University of Melbourne Parkville Victoria Australia
- Parkville Familial Cancer Centre, Peter McCallum Cancer Centre Melbourne Victoria Australia
- Discipline of Genetic Counselling, Graduate School of Health The University of Technology Sydney Sydney New South Wales Australia
| | - Laura E. Forrest
- Genomic Medicine & Familial Cancer Centre Royal Melbourne Hospital Parkville Victoria Australia
- Parkville Familial Cancer Centre, Peter McCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville Victoria Australia
| | - Paul James
- Genomic Medicine & Familial Cancer Centre Royal Melbourne Hospital Parkville Victoria Australia
- Parkville Familial Cancer Centre, Peter McCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology The University of Melbourne Parkville Victoria Australia
| | - James Dowty
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health The University of Melbourne Parkville Victoria Australia
| | - Jessica Taylor
- Genomic Medicine & Familial Cancer Centre Royal Melbourne Hospital Parkville Victoria Australia
- Parkville Familial Cancer Centre, Peter McCallum Cancer Centre Melbourne Victoria Australia
| | - Jehannine Austin
- Department of Psychiatry and Medical Genetics University of British Columbia Vancouver British Columbia Canada
| | - Ingrid Winship
- Genomic Medicine & Familial Cancer Centre Royal Melbourne Hospital Parkville Victoria Australia
- Department of Medicine The University of Melbourne Parkville Victoria Australia
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Radu M, Ciucă A, Crișan CA, Pintea S, Predescu E, Șipos R, Moldovan R, Băban A. The impact of psychiatric disorders on caregivers: An integrative predictive model of burden, stigma, and well-being. Perspect Psychiatr Care 2022; 58:2372-2382. [PMID: 35347717 PMCID: PMC9790354 DOI: 10.1111/ppc.13071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The study investigates the predictors of caregivers' experienced burden, stigma, and well-being, when looking after family members diagnosed with a psychiatric disorder. DESIGN AND METHODS This cross-sectional study included 168 caregivers; perceived burden, stigma, well-being, knowledge, illness perception, and medical variables were assessed. FINDINGS A number of correlates of burden, stigma, and well-being have been identified and are being discussed. The integrative predictive model showed that the caregiver's emotional representation of illness best predicts burden (β = 0.38, p < 0.001), stigma (β = 0.53, p < 0.001) and well-being (β = -0.36, p < 0.001). PRACTICE IMPLICATIONS Our results can enable health professionals to tailor psychosocial interventions addressed to family members of individuals living with a psychiatric condition.
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Affiliation(s)
- Mădălina Radu
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Andrada Ciucă
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Cătălina-Angela Crișan
- Department of Neurosciences, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sebastian Pintea
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Elena Predescu
- Department of Neuroscience, Discipline of Psychiatry and Pediatric Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Șipos
- Department of Neuroscience, Discipline of Psychiatry and Pediatric Psychiatry, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ramona Moldovan
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania.,Division of Evolution and Genomic Sciences, School of Biological Science, University of Manchester, Manchester, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Adriana Băban
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
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Perceptions of causal attribution and attitudes to genetic testing among people with schizophrenia and their first-degree relatives. Eur J Hum Genet 2022; 30:1147-1154. [PMID: 35577937 PMCID: PMC9553941 DOI: 10.1038/s41431-022-01116-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/28/2021] [Accepted: 04/28/2022] [Indexed: 12/15/2022] Open
Abstract
Rapid advances in the genetics of psychiatric disorders mean that diagnostic and predictive genetic testing for schizophrenia risk may one day be a reality. This study examined how causal attributions for schizophrenia contribute to interest in a hypothetical genetic test. People with schizophrenia and first-degree relatives of people with schizophrenia were recruited through a schizophrenia research bank and mental health organisation. Semi-structured telephone interviews were conducted with 13 individuals with schizophrenia and 8 first-degree relatives. Transcripts were subjected to a qualitative analysis using the thematic analysis framework. Five themes were developed: (i) "It is like a cocktail", with most participants aware that both genetic and environmental factors contributed to causation, and many mentioning the positive impact of genetic causal explanations; (ii) "Knowledge is power" (i.e., in favour of genetic testing); (iii) Genetic testing provides opportunities for early intervention and avoiding triggers, with participants citing a wide range of perceived benefits of genetic testing but few risks; (iv) Views on reproductive genetic testing for schizophrenia risk with a few participants viewing it as "playing God" but not necessarily being against it; and (v) "It snowballs", whereby participants' understanding of genetics was sophisticated with most believing that multiple rather than single genes contributed to schizophrenia. In conclusion, many individuals had a sound understanding of the role of genetic testing if it were to become available, with evidence of insight into the role of multiple genes and the contribution of other risk factors that may interact with any inherited genetic risk.
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8
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An ethical analysis of divergent clinical approaches to the application of genetic testing for autism and schizophrenia. Hum Genet 2021; 141:1069-1084. [PMID: 34453583 DOI: 10.1007/s00439-021-02349-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/16/2021] [Indexed: 12/27/2022]
Abstract
Genetic testing to identify genetic syndromes and copy number variants (CNVs) via whole genome platforms such as chromosome microarray (CMA) or exome sequencing (ES) is routinely performed clinically, and is considered by a variety of organizations and societies to be a "first-tier" test for individuals with developmental delay (DD), intellectual disability (ID), or autism spectrum disorder (ASD). However, in the context of schizophrenia, though CNVs can have a large effect on risk, genetic testing is not typically a part of routine clinical care, and no clinical practice guidelines recommend testing. This raises the question of whether CNV testing should be similarly performed for individuals with schizophrenia. Here we consider this proposition in light of the history of genetic testing for ID/DD and ASD, and through the application of an ethical analysis designed to enable robust, accountable and justifiable decision-making. Using a systematic framework and application of relevant bioethical principles (beneficence, non-maleficence, autonomy, and justice), our examination highlights that while CNV testing for the indication of ID has considerable benefits, there is currently insufficient evidence to suggest that overall, the potential harms are outweighed by the potential benefits of CNV testing for the sole indications of schizophrenia or ASD. However, although the application of CNV tests for children with ASD or schizophrenia without ID/DD is, strictly speaking, off-label use, there may be clinical utility and benefits substantive enough to outweigh the harms. Research is needed to clarify the harms and benefits of testing in pediatric and adult contexts. Given that genetic counseling has demonstrated benefits for schizophrenia, and has the potential to mitigate many of the potential harms from genetic testing, any decisions to implement genetic testing for schizophrenia should involve high-quality evidence-based genetic counseling.
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9
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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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10
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Yu BCL, Chio FHN, Mak WWS, Corrigan PW, Chan KKY. Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach. Clin Psychol Rev 2021; 87:102029. [PMID: 34058604 DOI: 10.1016/j.cpr.2021.102029] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
This meta-analytic study synthesized findings from 108 independent data sets across 22 cultures to investigate whether the stigma internalization model (the internalization of experienced stigma and perceived stigma to self-stigma) is associated with well-being and recovery of people with mental illness. We also examined the moderating role of collectivism in the internalization process. Results of the meta-analytic structural equation modeling suggested that self-stigma is a significant mediator in the relationships between experienced stigma and perceived stigma with well-being and recovery variables (indirect effects = 0.02 to -0.16). Experienced and perceived stigma had significant direct effects on well-being and recovery variables (Bs = 0.07 to -0.21, p < 0.05), suggesting that both external (e.g., public stigma) and internal (i.e., self-stigma) influences of stigma work concurrently to affect recovery and well-being of people with mental illness. The results of the mixed effect three-level meta-analytic models showed that collectivism significantly moderated the relationship between experienced and perceived stigma with self-stigma (Bs = 0.06 to 0.11, p < 0.05). This implied that the more collectivistic a culture is, the stronger the correlation between experienced and perceived stigma with self-stigma. Implications to stigma reduction approaches were discussed.
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Affiliation(s)
- Ben C L Yu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Floria H N Chio
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
| | - Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, United States
| | - Kelly K Y Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
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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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Bourdon JL, Davies RA, Long EC. Four Actionable Bottlenecks and Potential Solutions to Translating Psychiatric Genetics Research: An Expert Review. Public Health Genomics 2020; 23:171-183. [PMID: 33147585 PMCID: PMC7854816 DOI: 10.1159/000510832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Psychiatric genetics has had limited success in translational efforts. A thorough understanding of the present state of translation in this field will be useful in the facilitation and assessment of future translational progress. PURPOSE A narrative literature review was conducted. Combinations of 3 groups of terms were searched in EBSCOhost, Google Scholar, and PubMed. The review occurred in multiple steps, including abstract collection, inclusion/exclusion criteria review, coding, and analysis of included papers. RESULTS One hundred and fourteen articles were analyzed for the narrative review. Across those, 4 bottlenecks were noted that, if addressed, may provide insights and help improve and increase translation in the field of psychiatric genetics. These 4 bottlenecks are emphasizing linear translational frameworks, relying on molecular genomic findings, prioritizing certain psychiatric disorders, and publishing more reviews than experiments. CONCLUSIONS These entwined bottlenecks are examined with one another. Awareness of these bottlenecks can inform stakeholders who work to translate and/or utilize psychiatric genetic information. Potential solutions include utilizing nonlinear translational frameworks as well as a wider array of psychiatric genetic information (e.g., family history and gene-environment interplay) in this area of research, expanding which psychiatric disorders are considered for translation, and when possible, conducting original research. Researchers are urged to consider how their research is translational in the context of the frameworks, genetic information, and psychiatric disorders discussed in this review. At a broader level, these efforts should be supported with translational efforts in funding and policy shifts.
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Affiliation(s)
- Jessica L Bourdon
- Department of Psychiatry, Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA,
| | - Rachel A Davies
- Yerkes National Primate Research Center, Division of Behavioral Neuroscience and Psychiatric Disorders, Emory University, Atlanta, Georgia, USA
| | - Elizabeth C Long
- Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania, USA
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13
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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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14
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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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15
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Assessing Stakeholder Perceptions of the Utility of Genetic Information for the Clinical Care of Mental Health Disorders: We Have a Will but Need to See the Way. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:363-376. [PMID: 32564165 DOI: 10.1007/s10488-020-01058-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Academic stakeholders' (primarily mental health researchers and clinicians) practices and attitudes related to the translation of genetic information into mental health care were assessed. A three-part survey was administered at two large, urban universities. Response frequencies were calculated. Participants (N = 64) reported moderate levels of translational practice, adequate levels of genetic knowledge, and variable levels of genetic competence. They held positive attitudes toward translating genetic information about mental health broadly but negative attitudes about the impact that such information would have on specific aspects of care. The current study lays the groundwork for further inquiry into translating genetic information to mental health care.
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16
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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: 53] [Impact Index Per Article: 13.3] [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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17
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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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18
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Lázaro-Muñoz G, Sabatello M, Huckins L, Peay H, Degenhardt F, Meiser B, Lencz T, Soda T, Docherty A, Crepaz-Keay D, Austin J, Peterson RE, Davis LK. International Society of Psychiatric Genetics Ethics Committee: Issues facing us. Am J Med Genet B Neuropsychiatr Genet 2019; 180:543-554. [PMID: 31124312 PMCID: PMC6861601 DOI: 10.1002/ajmg.b.32736] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/21/2019] [Accepted: 05/10/2019] [Indexed: 12/19/2022]
Abstract
Psychiatric genetics research is improving our understanding of the biological underpinnings of neurodiversity and mental illness. Using psychiatric genetics in ways that maximize benefits and minimize harms to individuals and society depends largely on how the ethical, legal, and social implications (ELSI) of psychiatric genetics are managed. The International Society of Psychiatric Genetics (ISPG) is the largest international organization dedicated to psychiatric genetics. Given its history, membership, and international reach, we believe the ISPG is well-equipped to contribute to the resolution of these ELSI challenges. As such, we recently created the ISPG Ethics Committee, an interdisciplinary group comprised of psychiatric genetics researchers, clinical geneticists, genetic counselors, mental health professionals, patients, patient advocates, bioethicists, and lawyers. This article highlights key ELSI challenges identified by the ISPG Ethics Committee to be of paramount importance for the ethical translation of psychiatric research into society in three contexts: research settings, clinical settings, and legal proceedings. For each of these arenas, we identify and discuss pressing psychiatric genetics ELSI dilemmas that merit attention and require action. The goal is to increase awareness about psychiatric genetics ELSI issues and encourage dialogue and action among stakeholders.
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Affiliation(s)
| | | | - Laura Huckins
- Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Holly Peay
- RTI International, Research Triangle Park, NC, USA 27709
| | | | - Bettina Meiser
- University of New South Wales, UNSW Sydney 2052, Australia
| | - Todd Lencz
- Hofstra University, Hempstead, NY, USA 11549
| | - Takahiro Soda
- University of North Carolina at Chapel Hill, NC, USA 27599
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19
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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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20
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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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21
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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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22
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Arango C, Díaz-Caneja CM, McGorry PD, Rapoport J, Sommer IE, Vorstman JA, McDaid D, Marín O, Serrano-Drozdowskyj E, Freedman R, Carpenter W. Preventive strategies for mental health. Lancet Psychiatry 2018; 5:591-604. [PMID: 29773478 DOI: 10.1016/s2215-0366(18)30057-9] [Citation(s) in RCA: 267] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/14/2022]
Abstract
Available treatment methods have shown little effect on the burden associated with mental health disorders. We review promising universal, selective, and indicated preventive mental health strategies that might reduce the incidence of mental health disorders, or shift expected trajectories to less debilitating outcomes. Some of these interventions also seem to be cost-effective. In the transition to mental illness, the cumulative lifetime effect of multiple small effect size risk factors progressively increases vulnerability to mental health disorders. This process might inform different levels and stages of tailored interventions to lessen risk, or increase protective factors and resilience, especially during sensitive developmental periods. Gaps between knowledge, policy, and practice need to be bridged. Future steps should emphasise mental health promotion, and improvement of early detection and interventions in clinical settings, schools, and the community, with essential support from society and policy makers.
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Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Patrick D McGorry
- Orygen, National Centre for Excellence in Youth Mental Health, and Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Judith Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Iris E Sommer
- Department of Neuroscience, University Medical Center Groningen, Groningen, Netherlands
| | - Jacob A Vorstman
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Program in Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - David McDaid
- Department of Health Policy at the London School of Economics and Social Science, London, UK
| | - Oscar Marín
- Centre for Developmental Neurobiology, Institute of Psychiatry, Psychology and Neuroscience, and MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - Elena Serrano-Drozdowskyj
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Centro de Investigación Biomédica en Red del área de Salud Mental (CIBERSAM), Madrid, Spain
| | - Robert Freedman
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - William Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Maryland Psychiatric Research Center, Baltimore, MD, USA
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23
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Maloney KA, Alaeddin DS, von Coelln R, Dixon S, Shulman LM, Schrader K, Guan Y. Parkinson’s Disease: Patients’ Knowledge, Attitudes, and Interest in Genetic Counseling. J Genet Couns 2018; 27:1200-1209. [DOI: 10.1007/s10897-018-0239-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 02/08/2018] [Indexed: 01/08/2023]
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24
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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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25
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Training to Provide Psychiatric Genetic Counseling: How Does It Impact Recent Graduates’ and Current Students’ Readiness to Provide Genetic Counseling for Individuals with Psychiatric Illness and Attitudes towards this Population? J Genet Couns 2017; 27:301-311. [DOI: 10.1007/s10897-017-0146-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 08/16/2017] [Indexed: 10/18/2022]
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26
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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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27
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Bassett AS, Costain G, Marshall CR. Neuropsychiatric aspects of 22q11.2 deletion syndrome: considerations in the prenatal setting. Prenat Diagn 2016; 37:61-69. [PMID: 27718271 DOI: 10.1002/pd.4935] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 09/21/2016] [Accepted: 10/03/2016] [Indexed: 12/20/2022]
Abstract
Most major neuropsychiatric outcomes of concern to families are not detectable by prenatal ultrasound. The introduction of genome-wide chromosomal microarray analysis to prenatal clinical diagnostic testing has increased the detection of pathogenic 22q11.2 deletions, which cause the most common genomic disorder. The recent addition of this and other microdeletions to non-invasive prenatal screening methods using cell-free fetal DNA has further propelled interest in outcomes. Conditions associated with 22q11.2 deletions include intellect ranging from intellectual disability to average, schizophrenia and other treatable psychiatric conditions, epilepsy, and early-onset Parkinson's disease. However, there is currently no way to predict how severe the lifetime expression will be. Available evidence suggests no major role in these neuropsychiatric outcomes for the congenital cardiac or most other structural anomalies that may be detectable on ultrasound. This article provides an outline of the lifetime neuropsychiatric phenotype of 22q11.2 deletion syndrome that will be useful to clinicians involved in prenatal diagnosis and related genetic counselling. The focus is on information that will be most relevant to two common situations: detection of a 22q11.2 deletion in a fetus or newborn, and new diagnosis of 22q11.2 deletion syndrome in a parent without a previous molecular diagnosis. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anne S Bassett
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada.,Department of Mental Health, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada.,Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Gregory Costain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Medical Genetics Residency Training Program, University of Toronto, Toronto, Ontario, Canada
| | - Christian R Marshall
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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28
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Stigma resistance is positively associated with psychiatric and psychosocial outcomes: A meta-analysis. Schizophr Res 2016; 175:118-128. [PMID: 27102423 DOI: 10.1016/j.schres.2016.03.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 01/21/2023]
Abstract
To better understand how stigma resistance impacts functioning-related domains, we examined mean effect sizes between stigma resistance and: 1) symptoms (overall, positive, negative, and mood symptoms); 2) self-stigma; 3) self-efficacy; 4) quality of life; 5) recovery; 6) hope; 7) insight, and 8) overall outcomes (the average effect size across the constructs examined in each study). The mean effect size between stigma resistance and overall outcomes was significant and positive (r=0.46, p<0.001, k=48). A large, negative effect size was found between stigma resistance and self-stigma (r=-0.57, p<0.001, k=40). Large, positive effect sizes were found with self-efficacy (r=0.60, p<0.001, k=25), quality of life (r=0.51, p<0.001, k=17), hope (r=0.54, p<0.001, k=8), and recovery (r=0.60, p<0.001, k=7). Stigma resistance had a significant medium and small relationship with insight and symptoms, respectively. Race significantly moderated overall outcomes, self-stigma, mood symptoms, functioning, and hope associations. Education significantly moderated symptoms, functioning, and mood symptoms associations, and age significantly moderated self-stigma and negative symptom associations. Stigma resistance may be a key requirement for recovery. Individual characteristics influence resisting stigma and future work should prioritize cultural factors surrounding stigma resistance.
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29
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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 DOI: 10.1007/s10897-016-9961-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [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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Tsang HWH, Ching SC, Tang KH, Lam HT, Law PYY, Wan CN. Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophr Res 2016; 173:45-53. [PMID: 26969450 DOI: 10.1016/j.schres.2016.02.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Internalized stigma can lead to pervasive negative effects among people with severe mental illness (SMI). Although prevalence of internalized stigma is high, there is a dearth of interventions and meanwhile a lack of evidence as to their effectiveness. This study aims at unraveling the existence of different therapeutic interventions and the effectiveness internalized stigma reduction in people with SMI via a systematic review and meta-analysis. METHODS Five electronic databases were searched. Studies were included if they (1) involved community or hospital based interventions on internalized stigma, (2) included participants who were given a diagnosis of SMI>50%, and (3) were empirical and quantitative in nature. RESULTS Fourteen articles were selected for extensive review and five for meta-analysis. Nine studies showed significant decrease in internalized stigma and two showed sustainable effects. Meta-analysis showed that there was a small to moderate significant effect in therapeutic interventions (SMD=-0.43; p=0.003). Among the intervention elements, four studies suggested a favorable effect of psychoeducation. Meta-analysis showed that there was small to moderate significant effect (SMD=-0.40; p=0.001). CONCLUSION Most internalized stigma reduction programs appear to be effective. This systematic review cannot make any recommendation on which intervention is more effective although psychoeducation seems most promising. More Randomized Controlled Trials (RCT) on particular intervention components using standard outcome measures are recommended in future studies.
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Affiliation(s)
- Hector W H Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
| | - S C Ching
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - K H Tang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - H T Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Peggy Y Y Law
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - C N Wan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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31
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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: 45] [Impact Index Per Article: 5.6] [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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32
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Obsessive-Compulsive Disorder: The Process of Parental Adaptation and Implications for Genetic Counseling. J Genet Couns 2015; 25:912-22. [PMID: 26639756 DOI: 10.1007/s10897-015-9914-9] [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: 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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33
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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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34
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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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35
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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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36
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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: 84] [Impact Index Per Article: 9.3] [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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37
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Baker K, Costain G, Fung WLA, Bassett AS. Chromosomal microarray analysis-a routine clinical genetic test for patients with schizophrenia. Lancet Psychiatry 2014; 1:329-31. [PMID: 26360988 DOI: 10.1016/s2215-0366(14)70308-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Kate Baker
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge CB2 0XY, UK.
| | - Gregory Costain
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wai Lun Alan Fung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Anne S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family Hearts and Minds Clinic for Adults with 22q11.2 Deletion Syndrome, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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38
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Doyle N, Cirino A, Trivedi A, Flynn M. Exploring Barriers to Payer Utilization of Genetic Counselors. J Genet Couns 2014; 24:122-33. [DOI: 10.1007/s10897-014-9745-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 07/08/2014] [Indexed: 10/24/2022]
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39
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Costain G, Lionel AC, Fu F, Stavropoulos DJ, Gazzellone MJ, Marshall CR, Scherer SW, Bassett AS. Adult neuropsychiatric expression and familial segregation of 2q13 duplications. Am J Med Genet B Neuropsychiatr Genet 2014; 165B:337-44. [PMID: 24807792 PMCID: PMC4464821 DOI: 10.1002/ajmg.b.32236] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/14/2014] [Indexed: 02/05/2023]
Abstract
New genomic disorders associated with large, rare, recurrent copy number variations (CNVs) are being discovered at a rapid pace. Detailed phenotyping and family studies are rare, however, as are data on adult phenotypic expression. Duplications at 2q13 were recently identified as risk factors for developmental delay/autism and reported in the prenatal setting, yet few individuals (all children) have been extensively phenotyped. During a genome-wide CNV study of schizophrenia, we identified two unrelated probands with 2q13 duplications. In this study, detailed phenotyping and genotyping using high-resolution microarrays was performed for 12 individuals across their two families. 2q13 duplications were present in six adults, and co-segregated with clinically significant later-onset neuropsychiatric disorders. Convergent lines of evidence implicated GABAminergic dysfunction. Analysis of the genic content revealed promising candidates for neuropsychiatric disease, including BCL2L11, ANAPC1, and MERTK. Intrafamilial genetic heterogeneity and "second hits" in one family may have been the consequence of assortative mating. Clinical genetic testing for the 2q13 duplication and the associated genetic counseling was well received. In summary, large rare 2q13 duplications appear to be associated with variable adult neuropsychiatric and other expression. The findings represent progress toward clinical translation of research results in schizophrenia. There are implications for other emerging genomic disorders where there is interest in lifelong expression.
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Affiliation(s)
- Gregory Costain
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Anath C. Lionel
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics and McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada
| | - Fiona Fu
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Dimitri J. Stavropoulos
- Department of Pediatric Laboratory Medicine, Cytogenetics Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Matthew J. Gazzellone
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics and McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada
| | - Christian R. Marshall
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics and McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W. Scherer
- The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Molecular Genetics and McLaughlin Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anne S. Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
- Division of Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Correspondence to: Anne S. Bassett, MD, FRCPC, Centre for Addiction and Mental Health, 33 Russell Street, Room 1100, Toronto, Ontario, Canada M5S 2S1.
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40
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Costain G, Bassett AS. Individualizing recurrence risks for severe mental illness: epidemiologic and molecular genetic approaches. Schizophr Bull 2014; 40:21-3. [PMID: 24045037 PMCID: PMC3885305 DOI: 10.1093/schbul/sbt133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Gregory Costain
- *To whom correspondence should be addressed; Clinical Genetics Research Program, Centre for Addiction and Mental Health, 33 Russell Street, Room 1100, Toronto, ON M5S 2S1, Canada; tel: 416-535-8501 ext. 32731, fax: 416-535-7199, e-mail:
| | - Anne S. Bassett
- *To whom correspondence should be addressed; Clinical Genetics Research Program, Centre for Addiction and Mental Health, 33 Russell Street, Room 1100, Toronto, ON M5S 2S1, Canada; tel: 416-535-8501 ext. 32731, fax: 416-535-7199, e-mail:
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41
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Lee M, Rebora P, Valsecchi MG, Czene K, Reilly M. A unified model for estimating and testing familial aggregation. Stat Med 2013; 32:5353-65. [DOI: 10.1002/sim.6025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 09/24/2013] [Accepted: 09/30/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Myeongjee Lee
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; 17177 Stockholm Sweden
| | - Paola Rebora
- Center of Biostatistics for Clinical Epidemiology, Department of Health Science; University of Milano-Bicocca; Monza Italy
| | - Maria Grazia Valsecchi
- Center of Biostatistics for Clinical Epidemiology, Department of Health Science; University of Milano-Bicocca; Monza Italy
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; 17177 Stockholm Sweden
| | - Marie Reilly
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; 17177 Stockholm Sweden
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Costain G, Lionel AC, Merico D, Forsythe P, Russell K, Lowther C, Yuen T, Husted J, Stavropoulos DJ, Speevak M, Chow EWC, Marshall CR, Scherer SW, Bassett AS. Pathogenic rare copy number variants in community-based schizophrenia suggest a potential role for clinical microarrays. Hum Mol Genet 2013; 22:4485-501. [PMID: 23813976 DOI: 10.1093/hmg/ddt297] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Individually rare, large copy number variants (CNVs) contribute to genetic vulnerability for schizophrenia. Unresolved questions remain, however, regarding the anticipated yield of clinical microarray testing in schizophrenia. Using high-resolution genome-wide microarrays and rigorous methods, we investigated rare CNVs in a prospectively recruited community-based cohort of 459 unrelated adults with schizophrenia and estimated the minimum prevalence of clinically significant CNVs that would be detectable on a clinical microarray. A blinded review by two independent clinical cytogenetic laboratory directors of all large (>500 kb) rare CNVs in cases and well-matched controls showed that those deemed to be clinically significant were highly enriched in schizophrenia (16.4-fold increase, P < 0.0001). In a single community catchment area, the prevalence of individuals with these CNVs was 8.1%. Rare 1.7 Mb CNVs at 2q13 were found to be significantly associated with schizophrenia for the first time, compared with the prevalence in 23 838 population-based controls (42.9-fold increase, P = 0.0002). Additional novel findings that will facilitate the future clinical interpretation of smaller CNVs in schizophrenia include: (i) a greater proportion of individuals with two or more rare exonic CNVs >10 kb in size (1.5-fold increase, P = 0.0109) in schizophrenia; (ii) the systematic discovery of new candidate genes for schizophrenia; and, (iii) functional gene enrichment mapping highlighting a differential impact in schizophrenia of rare exonic deletions involving diverse functions, including neurodevelopmental and synaptic processes (4.7-fold increase, P = 0.0060). These findings suggest consideration of a potential role for clinical microarray testing in schizophrenia, as is now the suggested standard of care for related developmental disorders like autism.
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Affiliation(s)
- Gregory Costain
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, ON, Canada M5S 2S1
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