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Anticipating the Ethical Challenges of Psychiatric Genetic Testing

  • Genetic Disorders (F Goes, Section Editor)
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Abstract

Purpose of Review

Genetic testing for mental illness is likely to become increasingly prevalent as the science behind it is refined. This article identifies anticipated ethical challenges for patients, psychiatrists, and genetic counselors and makes recommendations for addressing them.

Recent Findings

Many of the ethical challenges of psychiatric genetic testing are likely to stem from failures to comprehend the nature and implications of test results. Recent studies have identified gaps in the knowledge base of psychiatrists and genetic counselors, which limit their abilities to provide patients with appropriate education. A small number of studies have demonstrated the value of counseling in empowering patients to deal with relevant genetic information.

Summary

Psychiatrists and other health professionals must be able to assist patients and families in making informed decisions about genetic testing and interpreting test results. Filling their knowledge gaps on these issues will be a critical step towards meeting these responsibilities.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Couzin J. Gene tests for psychiatric risk polarize researchers. Science. 2008;319:274–7.

    Article  CAS  PubMed  Google Scholar 

  2. Austin J. Genetic testing for psychiatric disorders: its role in clinical psychiatric practice. Psychiatr Times. 2013:15–7.

  3. Mitchell PB, Meiser B, Wilde A, Fullerton J, Donald J, Wilhelm K, et al. Predictive and diagnostic genetic testing in psychiatry. Psychiatr Genet. 2010;33:225–43.

    Google Scholar 

  4. Samson JN, Wong AHC. 2015 The genetics of schizophrenia. In: Lipina TV, Roder JC, editors. Drug Discovery in Schizophrenia. Royal Society of Chemistry.

  5. Schizophrenia Working Group of the Psychiatric Genomics Consortium. Biological insights from 108 schizophrenia-associated genetic loci. Nature. 2014;511:421–7.

    Article  PubMed Central  Google Scholar 

  6. Hyde CL, Nagle MW, Tian C, Chen X, Paciga SA, Wendland JR, et al. Identification of 15 genetic loci associated with risk of major depression in individuals of European descent. Nat Genet. 2016;48:1031–6.

    Article  CAS  PubMed  Google Scholar 

  7. Uher R. Gene–environment interactions in common mental disorders: an update and strategy for a genome-wide search. Soc Psychiatry Psychiatr Epidemiol. 2014;49:3–14.

    Article  PubMed  Google Scholar 

  8. •• Dubovsky SL. The limitations of genetic testing in psychiatry. Psychother Psychosom. 2016;85:129–35. Thorough evaluation of the challenges and limitations of genetic testing for psychiatric disorders, including an excellent review of relevant genetic testing and treatment studies

    Article  PubMed  Google Scholar 

  9. Zandi PP, Judy JT. The promise and reality of pharmacogenetics in psychiatry. Psychiatr Clin North Am. 2010;33:181–224.

    Article  PubMed  PubMed Central  Google Scholar 

  10. •• Salm M, Abbate K, Appelbaum P, Ottman R, Chung W, Marder K, et al. Use of genetic tests among neurologists and psychiatrists: knowledge, attitudes, behaviors, and needs for training. J Genet Couns. 2014;23:156–63. Important study of neurologists’ and psychiatrists’ opinions and practices concerning genetic tests, finding that most believed such tests important but were concerned about possible psychological harm to patients, and that almost half of respondents lacked a genetics professional for patient referrals

    Article  PubMed  Google Scholar 

  11. Lawrence RE, Appelbaum PS. Genetic testing in psychiatry: a review of attitudes and beliefs. Psychiatry. 2011;74:315–31.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lebowitz MS, Ahn W, Nolen-Hoeksema S. Fixable or fate? Perceptions of the biology of depression. J Consult Clin Psychol. 2013;81:518–27.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lebowitz MS, Ahn W. Effects of biological explanations for mental disorders on clinicians’ empathy. Proc Natl Acad Sci. 2014;111:17786–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Austin JC, Smith GN, Honer WG. The genomic era and perceptions of psychotic disorders: genetic risk estimation, associations with reproductive decisions and views about predictive testing. Am J Med Genet B Neuropsychiatr Genet 2006;141B:926–928.

  15. DeLisi LE, Bertisch H. A preliminary comparison of the hopes of researchers, clinicians, and families for the future ethical use of genetic findings on schizophrenia. Am J Med Genet B Neuropsychiatr Genet. 2006;141B:110–5.

    Article  PubMed  Google Scholar 

  16. Laegsgaard MM, Kristensen AS, Mors O. Potential consumers’ attitudes toward psychiatric genetic research and testing and factors influencing their intentions to test. Genet Test Mol Biomark. 2009;13:57–65.

    Article  Google Scholar 

  17. Meiser B, Mitchell PB, Kasparian NA, Strong K, Simpson JM, Mireskandari S, et al. Attitudes towards childbearing, causal attributions for bipolar disorder and psychological distress: a study of families with multiple cases of bipolar disorder. Psychol Med. 2007;37:1601–11.

    Article  PubMed  Google Scholar 

  18. Meiser B, Kasparian NA, Mitchell PB, Strong K, Simpson JM, Tabassum L, et al. Attitudes to genetic testing in families with multiple cases of bipolar disorder. Genet Test. 2008;12:233–43.

    Article  CAS  PubMed  Google Scholar 

  19. Friedman Ross L, Saal HM, David KL, Anderson RR. American Academy of Pediatrics, American College of Medical Genetics and Genomics. Technical report: ethical and policy issues in genetic testing and screening of children. Genet Med. 2013;15:234–45.

    Article  Google Scholar 

  20. Appelbaum PS. Who’s afraid of psychiatric genomics? Am J Bioeth. 2017;17(4):15–7.

  21. Lawrence RE, Friesen P, Brucato G, Girgis RR, Dixon L. Concerns about genetic testing for schizophrenia among young adults at clinical high risk for psychosis. AJOB Empir Bioeth. 2016;7:193–8.

    Article  PubMed  Google Scholar 

  22. Egalite N, Groisman IJ, Godard B. Genetic counseling practice in next generation sequencing research: implications for the ethical oversight of the informed consent process. J Genet Couns. 2014;23:661–70.

    Article  PubMed  Google Scholar 

  23. Shirts BH, Parker LS. Changing interpretations, stable genes: responsibilities of patients, professionals, and policy makers in the clinical interpretation of complex genetic information. Genet Med. 2008;10:778–83.

    Article  PubMed  Google Scholar 

  24. Roche MI, Berg JS. Incidental findings with genomic testing: implications for genetic counseling practice. Curr Genet Med Rep. 2015;3:166–76.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Appelbaum PS, Fyer A, Klitzman RL, Martinez J, Parens E, Zhang Y, et al. Researchers’ views on informed consent for return of secondary results in genomic research. Genet Med. 2015;17:644–50.

    Article  PubMed  Google Scholar 

  26. Aziz N, Zhao Q, Bry L, Driscoll DK, Funke B, Gibson JS, et al. College of American Pathologists’ laboratory standards for next-generation sequencing clinical tests. Arch Pathol Lab Med. 2015;139:481–93.

    Article  PubMed  Google Scholar 

  27. Dar-Nimrod I, Heine SJ. Genetic essentialism: on the deceptive determinism of DNA. Psychol Bull. 2011;137:800–18.

    Article  PubMed  PubMed Central  Google Scholar 

  28. • Friesen P, Lawrence RE, Brucato G, Girgis RR, Dixon L. Hopes and expectations regarding genetic testing for schizophrenia among young adults at clinical high-risk for psychosis. J Psychiatr Pract. 2016;22:442–9. Qualitative study of 15 young adults at clinical high-risk for psychosis to evaluate understanding of and hopes regarding genetic testing for schizophrenia; this article includes a recommendation for incorporation of genetic counseling to help counteract genetic optimism and educate young adults about the limitations of genetic testing

    Article  PubMed  Google Scholar 

  29. Appelbaum PS. Genetic discrimination in mental disorders: the impact of the Genetic Information Nondiscrimination Act. Psychiatr Serv. 2010;61:338–40.

  30. Sankar P, Cho MK, Wolpe PR, Schairer C. What is in a cause? Exploring the relationship between genetic cause and felt stigma. Genet Med. 2006;8:33–42.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Phelan JC, Bromet EJ, Link BG. Psychiatric illness and family stigma. Schizophr Bull. 1998;24:115–26.

    Article  CAS  PubMed  Google Scholar 

  32. Hinshaw SP. The stigmatization of mental illness in children and parents: developmental issues, family concerns, and research needs. J Child Psychol Psychiatry. 2005;46:714–34.

    Article  PubMed  Google Scholar 

  33. Angermeyer MC, Schulze B, Dietrich S. Courtesy stigma: a focus group study of relatives of schizophrenia patients. Soc Psychiatry Psychiatr Epidemiol. 2003;38:593–602.

    Article  PubMed  Google Scholar 

  34. Chapple A, May C, Campion P. Parental guilt: the part played by the clinical geneticist. J Genet Couns. 1995;4:179–91.

    Article  CAS  PubMed  Google Scholar 

  35. Trippitelli CL, Jamison KR, Folstein MF, Bartko JJ, DePaulo JR. Pilot study on patients’ and spouses’ attitudes toward potential genetic testing for bipolar disorder. Am J Psychiatry. 1998;155:899–904.

    Article  CAS  PubMed  Google Scholar 

  36. Gershon ES, Alliey-Rodriguez N. New ethical issues for genetic counseling in common mental disorders. Am J Psychiatry. 2013;170:968–76.

    Article  PubMed  Google Scholar 

  37. Suther S, Kiros G-E. Barriers to the use of genetic testing: a study of racial and ethnic disparities. Genet Med. 2009;11:655–62.

    Article  PubMed  Google Scholar 

  38. Jenkins S, Arribas-Ayllon M. Genetic counselling for psychiatric disorders: accounts of psychiatric health professionals in the United Kingdom. J Genet Couns. 2016;25:1243–55.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Hoop JG, Roberts LW, Hammond KAG, Cox NJ. Psychiatrists’ attitudes, knowledge, and experience regarding genetics: a preliminary study. Genet Med. 2008;10:439–49.

    Article  PubMed  Google Scholar 

  40. Finn CT, Smoller JW. Genetic counseling in psychiatry. Harv Rev Psychiatry. 2006;14:109–21.

    Article  PubMed  Google Scholar 

  41. Tsuang DW, Faraone SV, Tsuang MT. Genetic counseling for psychiatric disorders. Curr Psychiatry Rep. 2001;3:138–43.

    Article  CAS  PubMed  Google Scholar 

  42. •• 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. Important study of individuals with non-syndromic psychiatric disorders and their families, assessing the impact of genetic counseling and finding it to increase empowerment

    Article  CAS  PubMed  Google Scholar 

  43. • Hippman C, Ringrose A, Inglis A, Cheek J, Albert AYK, Remick R, et al. A pilot randomized clinical trial evaluating the impact of genetic counseling for serious mental illnesses. J Clin Psychiatry. 2016;77(2):e190–8. doi:10.4088/JCP.14m09710. This controlled trial studied participants’ understanding and perception of their illness, and assessed the impact of genetic counseling. The authors recommend that genetic counseling should be considered for patients with serious mental illnesses

    Article  PubMed  PubMed Central  Google Scholar 

  44. National Society of Genetic Counselors: who are genetic counselors? [Internet]. [cited 2017 Mar 9]. Available from: http://www.nsgc.org/page/whoaregcs

  45. Peay H, McInerney J. A pilot study on psychiatric genetic counseling: counselors’ needs. J Genet Couns. 2002;11:485. [abstract]

    Google Scholar 

  46. Monaco LC, Conway L, Valverde K, Austin JC. Exploring genetic counselors’ perceptions of and attitudes towards schizophrenia. Public Health Genomics. 2010;13:21–6.

    Article  PubMed  Google Scholar 

  47. Hunter MJ, Hippman C, Honer WG, Austin JC. Genetic counseling for schizophrenia: a review of referrals to a provincial medical genetics program from 1968–2007. Am J Med Genet A. 2010;152A:147–52.

    Article  CAS  PubMed  Google Scholar 

  48. Maintenance of certification: continuing medical education [Internet]. Am Board Psychiatry Neurol. [cited 2017 Mar 9]. Available from: https://www.abpn.com/maintain-certification/moc-activity-requirements/continuing-medical-education-cme/

  49. PA State Board of Medicine. CE requirements for genetic counselors [Internet]. Jan 1, 2015. Available from: http://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Documents/Board%20Documents/MedM%20-%20CME%20Genetic%20Counselors.pdf

  50. National Society of Genetic Counselors: states issuing licenses for genetic counselors [Internet]. [cited 2017 Mar 9]. Available from: http://www.nsgc.org/p/cm/ld/fid=19

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Acknowledgements

This work was supported by grants from the National Human Genome Research Institute (P50HG007257 and U01HG008680).

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Correspondence to Paul S. Appelbaum.

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Conflict of Interest

Paul S. Appelbaum and Shawna Benston report a grant from the National Human Genome Research Institute.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Genetic Disorders

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Appelbaum, P.S., Benston, S. Anticipating the Ethical Challenges of Psychiatric Genetic Testing. Curr Psychiatry Rep 19, 39 (2017). https://doi.org/10.1007/s11920-017-0790-x

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  • DOI: https://doi.org/10.1007/s11920-017-0790-x

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